Ocular Surface Evaluation in Immunoglobulin G4-related Ophthalmic Disease.

Aug 07, 2023

Contributors: Kenneth K H Lai,Xulin Liao,Fatema Mohamed Ali Abdulla Aljufairi,Yiu Man Wong,Jamie T Chiu,H T Mak,Andy C O Cheng,Joyce K Y Chin,Benjamin C Y Chu,Chi Ho Kwong,Kenneth K W Li,W H Chan,Wilson W K Yip,Alvin L Young,Edwin Chan,Callie K L Ko,Simon T C Ko,Carmen K M Chan,Hunter K L Yuen,Li Jia Chen,Clement C Tham,Chi Pui Pang,Kelvin K L Chong

To evaluate the functional and structural changes of the meibomian glands and ocular surface in Immunoglobulin G4-related ophthalmic disease (IgG4-ROD) patients.
Cross-sectional, matched case-control comparison study.
This study included 64 biopsy-proven IgG4-ROD patients (aged 63.4±12.2 years, 39 males) and 64 sex- and age-matched healthy controls. Patients were managed by hospitals covering the publicly funded ophthalmology service in Hong Kong. Outcome measures including anterior segment examination. keratographic and meibographic imagings.
A total of 64 worst-affected eyes of the 64 IgG4-ROD patients were analysed. Corneal fluorescein staining (P=0.0187), lid margin telangiectasia (P=0.0360), lidparallel conjunctival folds (P=0.0112), papillae (P=0.0393), meibomian gland plugging (P=0.0001), meibomian gland expressibility (P=0.0001), and meibum quality (P=0.0001) were more significant in IgG4-ROD patients compared with healthy controls. Both upper and lower meibomian gland dropouts (P=0.001 and 0.0003), and tear meniscus height (P=0.0001) were higher in IgG4-ROD patients. Non-invasive tear break-up time(NITBUT) (P=0.0166) and Schirmer’s test (P=0.0243) were lower in IgG4-ROD patients. Upper (r=0.336, P=0.0140) meibomian gland dropouts, and NITBUT (r=-0.293, P=0.0497) were positively and negatively correlated with the IgG4-ROD onset age, respectively. The number of extraocular organ involvement was negatively correlated with the Schirmer test(r=-0.341, P=0.0167). Lower NITBUT was found in IgG4-ROD eyes with lacrimal gland enlargement than IgG4-ROD eyes without lacrimal gland enlargement radiologically (P<0.0001).
IgG4-ROD patients showed features of both aqueous tear deficiency and evaporative dry eye disease. We recommend ocular surface evaluation to all newly diagnosed IgG4-ROD patients. Further studies are warranted to clarify the mechanism of IgG4-related dry eye disease.

Copyright © 2023. Published by Elsevier Inc.

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ABOUT THE CONTRIBUTORS

Kenneth K H Lai,Xulin Liao,Fatema Mohamed Ali Abdulla Aljufairi,Yiu Man Wong,Jamie T Chiu,H T Mak,Andy C O Cheng,Joyce K Y Chin,Benjamin C Y Chu,Chi Ho Kwong,Kenneth K W Li,W H Chan,Wilson W K Yip,Alvin L Young,Edwin Chan,Callie K L Ko,Simon T C Ko,Carmen K M Chan,Hunter K L Yuen,Li Jia Chen,Clement C Tham,Chi Pui Pang,Kelvin K L Chong
Kenneth K H Lai

Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong Special Administrative Region, China; Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.

Xulin Liao

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.

Fatema Mohamed Ali Abdulla Aljufairi

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Ophthalmology, Salmaniya Medical Complex, Government Hospitals, Bahrain.

Yiu Man Wong

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.

Jamie T Chiu

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.

H T Mak

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.

Andy C O Cheng

Department of Ophthalmology, Hong Kong Sanatorium & Hospital, Hong Kong Special Administrative Region, China.

Joyce K Y Chin

Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.

Benjamin C Y Chu

Department of Ophthalmology, Grantham Hospital, Hong Kong Special Administrative Region, China.

Chi Ho Kwong

Department of Ophthalmology, Caritas Medical Center, Hong Kong Special Administrative Region, China.

Kenneth K W Li

Department of Ophthalmology, United Christian Hospital, Hong Kong Special Administrative Region, China.

W H Chan

Department of Ophthalmology, Tuen Mun Hospital, Hong Kong Special Administrative Region, China.

Wilson W K Yip

Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.

Alvin L Young

Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.

Edwin Chan

Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong Special Administrative Region, China.

Callie K L Ko

Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong Special Administrative Region, China.

Simon T C Ko

Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong Special Administrative Region, China.

Carmen K M Chan

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China.

Hunter K L Yuen

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China.

Li Jia Chen

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.

Clement C Tham

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong Special Administrative Region, China; Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China.

Chi Pui Pang

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.

Kelvin K L Chong

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong Special Administrative Region, China; Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China. Electronic address: chongkamlung@cuhk.edu.hk.