Ocular Surface Evaluation in Immunoglobulin G4-Related Ophthalmic Disease

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

doi:10.1016/j.ajo.2023.07.031

Ocular Surface Evaluation in Immunoglobulin G4-Related Ophthalmic Disease

Am J Ophthalmol. 2023 Dec:256:90-96. doi: 10.1016/j.ajo.2023.07.031. Epub 2023 Aug 5.

Authors

Kenneth K H Lai¹, Xulin Liao², Fatema Mohamed Ali Abdulla Aljufairi³, Yiu Man Wong², Jamie T Chiu², H T Mak², Andy C O Cheng⁴, Joyce K Y Chin⁵, Benjamin C Y Chu⁶, Chi Ho Kwong⁷, Kenneth K W Li⁸, W H Chan⁹, Wilson W K Yip⁵, Alvin L Young⁵, Edwin Chan¹⁰, Callie K L Ko¹⁰, Simon T C Ko¹⁰, Carmen K M Chan¹¹, Hunter K L Yuen¹¹, Li Jia Chen¹², Clement C Tham¹³, Chi Pui Pang², Kelvin K L Chong¹⁴

Affiliations

¹ From the Department of Ophthalmology (K.K.H.L., E.C., C.K.L.K., S.T.C.K.), Tung Wah Eastern Hospital, Hong Kong Special Administrative Region, China; Department of Ophthalmology and Visual Sciences (K.K.,H.L., X.L., F.M.A.A.A., Y.M.W., J.T.C., H.T.M., C.K.M.C., H.K.L.Yl, L.J.C., C.C.T., C.P.P., K.K.L.C.), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
² Department of Ophthalmology and Visual Sciences (K.K.,H.L., X.L., F.M.A.A.A., Y.M.W., J.T.C., H.T.M., C.K.M.C., H.K.L.Yl, L.J.C., C.C.T., C.P.P., K.K.L.C.), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
³ Department of Ophthalmology and Visual Sciences (K.K.,H.L., X.L., F.M.A.A.A., Y.M.W., J.T.C., H.T.M., C.K.M.C., H.K.L.Yl, L.J.C., C.C.T., C.P.P., K.K.L.C.), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Ophthalmology (F.M.A.A.A.), Salmaniya Medical Complex, Government Hospitals, Bahrain.
⁴ Department of Ophthalmology (A.C.O.C.), Hong Kong Sanatorium & Hospital, Hong Kong Special Administrative Region, China.
⁵ Department of Ophthalmology and Visual Sciences (J.K.Y.C., W.W.K.Y., A.L.Y., L.J.C., C.C.T., K.K.L.C.), Prince of Wales Hospital, Hong Kong Special Administrative Region, China.
⁶ Department of Ophthalmology (B.C.Y.C.), Grantham Hospital, Hong Kong Special Administrative Region, China.
⁷ Department of Ophthalmology (C.H.K.), Caritas Medical Center, Hong Kong Special Administrative Region, China.
⁸ Department of Ophthalmology (K.K.W.L.), United Christian Hospital, Hong Kong Special Administrative Region, China.
⁹ Department of Ophthalmology (W.H.C.), Tuen Mun Hospital, Hong Kong Special Administrative Region, China.
¹⁰ From the Department of Ophthalmology (K.K.H.L., E.C., C.K.L.K., S.T.C.K.), Tung Wah Eastern Hospital, Hong Kong Special Administrative Region, China.
¹¹ Department of Ophthalmology and Visual Sciences (K.K.,H.L., X.L., F.M.A.A.A., Y.M.W., J.T.C., H.T.M., C.K.M.C., H.K.L.Yl, L.J.C., C.C.T., C.P.P., K.K.L.C.), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Eye Hospital (C.K.M.C., H.K.L.Y., C.C.T., K.K.L.C.), Hong Kong Special Administrative Region, China.
¹² Department of Ophthalmology and Visual Sciences (K.K.,H.L., X.L., F.M.A.A.A., Y.M.W., J.T.C., H.T.M., C.K.M.C., H.K.L.Yl, L.J.C., C.C.T., C.P.P., K.K.L.C.), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Ophthalmology and Visual Sciences (J.K.Y.C., W.W.K.Y., A.L.Y., L.J.C., C.C.T., K.K.L.C.), Prince of Wales Hospital, Hong Kong Special Administrative Region, China.
¹³ Department of Ophthalmology and Visual Sciences (K.K.,H.L., X.L., F.M.A.A.A., Y.M.W., J.T.C., H.T.M., C.K.M.C., H.K.L.Yl, L.J.C., C.C.T., C.P.P., K.K.L.C.), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Ophthalmology and Visual Sciences (J.K.Y.C., W.W.K.Y., A.L.Y., L.J.C., C.C.T., K.K.L.C.), Prince of Wales Hospital, Hong Kong Special Administrative Region, China; Hong Kong Eye Hospital (C.K.M.C., H.K.L.Y., C.C.T., K.K.L.C.), Hong Kong Special Administrative Region, China.
¹⁴ Department of Ophthalmology and Visual Sciences (K.K.,H.L., X.L., F.M.A.A.A., Y.M.W., J.T.C., H.T.M., C.K.M.C., H.K.L.Yl, L.J.C., C.C.T., C.P.P., K.K.L.C.), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Ophthalmology and Visual Sciences (J.K.Y.C., W.W.K.Y., A.L.Y., L.J.C., C.C.T., K.K.L.C.), Prince of Wales Hospital, Hong Kong Special Administrative Region, China; Hong Kong Eye Hospital (C.K.M.C., H.K.L.Y., C.C.T., K.K.L.C.), Hong Kong Special Administrative Region, China. Electronic address: chongkamlung@cuhk.edu.hk.

PMID: 37544494
DOI: 10.1016/j.ajo.2023.07.031

Abstract

Purpose: To evaluate the functional and structural changes of the meibomian glands and ocular surface in immunoglobulin G4-related ophthalmic disease (IgG4-ROD) patients.

Design: Cross-sectional, matched case-control comparison study.

Methods: This study included 64 patients with biopsy-proven IgG4-ROD (aged 63.4 ± 12.2 years, 39 male) and 64 sex- and age-matched healthy controls. Patients were managed by hospitals covering the publicly funded ophthalmology service in Hong Kong. Outcome measures included anterior segment examination and keratographic and meibographic imagings.

Results: A total of 64 worst-affected eyes of the 64 IgG4-ROD patients were analyzed. Corneal fluorescein staining (P = .0187), lid margin telangiectasia (P = .0360), lid-parallel conjunctival folds (P = .0112), papillae (P = .0393), meibomian gland plugging (P = .0001), meibomian gland expressibility (P = .0001), and meibum quality (P = .0001) were more significant in IgG4-ROD patients compared with healthy controls. Both upper and lower meibomian gland dropouts (P = .001 and .0003), and tear meniscus height (P = .0001) were higher in IgG4-ROD patients. Non-invasive tear break-up time (NITBUT) (P = .0166) and Schirmer test results (P = .0243) were lower in IgG4-ROD patients. Upper (r = 0.336, P = .0140) meibomian gland dropouts and NITBUT (r = -0.293, P = .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 = .0167). Lower NITBUT was found in IgG4-ROD eyes with lacrimal gland enlargement than in IgG4-ROD eyes without lacrimal gland enlargement radiologically (P < .0001).

Conclusions: IgG4-ROD patients showed features of both aqueous tear deficiency and evaporative dry eye disease. We recommend ocular surface evaluation to all patients newly diagnosed with IgG4-ROD. Further studies are warranted to clarify the mechanism of IgG4-related dry eye disease.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Dry Eye Syndromes* / diagnosis
Humans
Immunoglobulin G
Lacrimal Apparatus*
Male
Meibomian Glands
Tears / chemistry

Substances

Immunoglobulin G