BackgroundOcular cicatricial pemphigoid (OCP) is a chronic, immune-mediated, fibrosing disease that can lead to blindness. The diagnosis is clinical and/or based on the results of the conjunctival biopsy. There are no studies that have studied the histopathological findings and the risk of clinical sequelae in this entity.ObjectivesThe describe biopsies from patients with OCP and to identify characteristics of the biopsies that may be associated with a greater risk of fibrosis and sequelae.MethodsA retrospective, multicentre study was carried out. Patients over 18 years of age with a diagnosis of OCP by pathology were selected. Medical records were reviewed and demographic, clinical, and biopsy data were collected. To assess whether histology was associated with greater or lesser fibrosis (determined by Foster’s stages), the patients were divided into two groups: early stages (0 and 1) versus stages 2, 3, and 4. The variables between the two groups were compared. groups. To determine whether immunofluorescence deposits were associated with a risk of sequelae over time, a Cox multivariate analysis was performed. Sequelae were defined as a multicomponent variable consisting of queratopia, xerophthalmia, entropion, trichiasis, cataracts, glaucoma, vitreous opacity, retinal scars, synechiae, and blindness.ResultsFifty-seven patients with POC diagnosed by pathology were included. The mean age of presentation at diagnosis was 62.7 (SD 13.2) years and 41 (71.9%) were women. The follow-up time was 1.5 years (2.9). Patients with early Foster (stages 0 and 1) were 50.9%. The presence of rounded and spindle-shaped mast cells was associated with early stages, while the presence of eosinophils was associated with later stages at the time of diagnosis. In the immunofluorescence the presence of IgM was more frequent in early stages and IgG in the later ones, with a predominant linear pattern (92%) (Table 1). During follow-up, 15 (27.3%) patients developed sequelae. In the multivariate Cox regression analysis, the presence of IgA resulted in risk during the follow-up period for the development of sequelae; IgA positive: HR 10.8, IC 95% 1.3 a 92.9 (p-value 0.03). IgG positive; HR 0.2, IC 95% 0.02 a 1.3 (p-value 0.08); IgM positive HR 0.4, IC 95% 0.1 a 2.3 (p-value 0.29) C3 positive HR 0.2, IC 95% 0.02 a 1.7 (p-value 0.14)ConclusionThis is one of the largest rheumatologic series that has evaluated the pathology in patients with OCP and provides information on the possible role that different antibody deposits could play in the conjunctival mucosa. The presence of IgA in the biopsy may have a role in the development of sequelae. Future larger and prospective studies could help to define the detection of different clinical patterns that give us a more accurate idea of the prognosis and treatment in these patients.Table 1.Biopsy´s characteristics according to Foster’s stage.TotalN= 57Early Foster (0 y 1)29 (50.9%)Advanced Foster (2, 3 y 4)28 (49.1%)P valueHipotrofic sectors, n (%)30 (65.2)15 (65.2)15 (65.2)1Decreased and/or absent goblet cells, n (%)40 (76.9)21 (80.7)19 (73.1)0.74Superficial parakeratosis, n (%)32 (58.2)18 (64.3)14 (51.8)0.35Lymphoplasmacytic infiltrates, n (%)48 (94.1)22 (91.7)26 (96.3)0.59Infiltrates at the mucosa-submucosa or chorion-epithelial interface, n (%)37 (88.1)15 (88.2)22 (88)1T lymphocytes, n (%)34 (85)12 (75)22 (91.7)0.19B lymphocytes, n (%)34 (85)12 (75)22 (91.7)0.19Rounded mast cells, n (%)35 (67.3)22 (81.5)13 (52)0.04Spindle mast cells, n (%)18 (38.3)12 (54.5)6 (24)0.03Degranulating mast cells, n (%)18 (40)9 (45)9 (36)0.54Monocytes/Neutrophils, n (%)32 (80)11 (73.3)21 (84)0.44Eosinophils, n (%)14 (37.8)2 (14.3)12 (52.2)0.03Fibrosis, n (%)27 (67.5)9 (56.2)18 (75)0.3Lymph ectasia, n (%)43 (82.7)23 (85.2)20 (80)0.72Deposits (linear)49 (92.4)27 (96.4)22 (88)0.33- IgG positive, n (%)25 (43.8)9 (31)16 (57.1)0.04- IgM positive, n (%)21 (36.8)15 (51.7)6 (21.4)0.02- IgA positive, n (%)36 (63.2)21 (72.4)15 (53.6)0.14- C3 positive, n (%)17 (29.8)6 (20.7)11 (39.3)0.12REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.