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Intravitreal administration of TAAC was safe and effective in recalcitrant cases of pseudophakic CME with a beneficial effect on the macular edema and visual acuity. A prospective randomized study is needed to determine with accuracy the efficacy, safety, and exact timing of this technique and possibly to recognize subtypes with a more favorable response. Repeated injections were required in all eyes. The development of a sustained-release intravitreal drug-delivery system would be beneficial.

Ocular cicatricial pemphigoid (OCP) is an autoimmune disease that affects mainly conjunctiva and other squamous epithelia. OCP is histologically characterized by a separation of the epithelium from underlying tissues within the basement membrane zone. Immunopathological studies demonstrate the deposition of anti-basement membrane zone autoantibodies in vivo. Purified IgG from sera of patients with active OCP identified a cDNA clone from a human keratinocyte cDNA library that had complete homology with the cytoplasmic domain of ␤4-integrin. The sera recognized a 205-kDa protein in human epidermal, human conjunctiva, and tumor cell lysates that was identified as ␤4-integrin by its reaction with polyclonal and monoclonal antibodies to human ␤4-integrin. Sera from patients with bullous pemphigoid, pemphigus vulgaris, and cicatricial pemphigoid-like diseases did not recognize the 205-kDa protein, indicating the specificity of the binding. These data strongly implicate a role for human ␤4-integrin in the pathogenesis of OCP. It should be emphasized that multiple antigens in the basement membrane zone of squamous epithelia may serve as targets for a wide spectrum of autoantibodies observed in vesiculobullous diseases. Molecular definition of these autoantigens will facilitate the classification and characterization of subsets of cicatricial pemphigoid and help distinguishing them from bullous pemphigoid. This study highlights the function and importance of ␤4-integrin in maintaining the attachment of epithelial cells to the basement membrane.Ocular cicatricial pemphigoid (OCP) is an uncommon potentially blinding systemic vesiculobullous autoimmune disease that affects mainly conjunctiva and other squamous epithelia (1, 2). OCP has some common pathophysiological features with other bullous diseases such as linear IgA bullous disease (LABD) and cicatricial pemphigoid (CP). In addition, the sera of patients with bullous pemphigoid (BP), epidermolysis bullosa aquisita, LABD, and CP (3, 4) frequently have demonstrable circulating autoantibodies that bind to different antigens of the basement membrane zone (BMZ) of skin and mucous membranes (5). Indirect immunofluorescence techniques are often inadequate to detect the circulating antibodies in sera of patients with OCP, because the autoantibody titer is very low. Immunoblot is now being used to study and characterize the OCP antigens and antibodies. Recent studies by immunoblot analysis indicated that OCP patients' sera recognize 230-, 205-, 180-, and 85-kDa proteins when normal human skin, human conjunctiva, and tumor cell lines were used as substrates (6). Some investigators have reported that like BP, CP patients' sera recognize the 230-and 180-kDa proteins when human epidermal lysate (HEL) and BPAg1 fusion proteins were used as substrates. They did not find binding of their sera to a 205-kDa protein (7). In contrast, we have shown that when the lysates containing the OCP antigens were first repeatedly preabsorbed with BP sera and then were tested with OCP patient...