免疫球蛋白 G4 相关眼病的眼表面评估。

Ocular Surface Evaluation in Immunoglobulin G4-Related Ophthalmic Disease.

机构信息

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.

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.

出版信息

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

DOI:10.1016/j.ajo.2023.07.031

PMID:37544494

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.

摘要

目的

评估 IgG4 相关眼病（IgG4-ROD）患者的睑板腺和眼表的功能和结构变化。

设计

横断面、匹配病例对照比较研究。

方法

本研究纳入了 64 名经活检证实的 IgG4-ROD 患者（年龄 63.4±12.2 岁，男性 39 名）和 64 名性别和年龄匹配的健康对照者。患者由覆盖香港公共资助眼科服务的医院管理。观察指标包括眼前节检查、角膜和睑板腺照相。

结果

对 64 例 IgG4-ROD 患者中最严重受累的 64 只眼进行了分析。与健康对照组相比，IgG4-ROD 患者的角膜荧光素染色（P=0.0187）、睑缘毛细血管扩张（P=0.0360）、与睑缘平行的结膜皱褶（P=0.0112）、乳头（P=0.0393）、睑板腺栓（P=0.0001）、睑板腺分泌功能（P=0.0001）和睑脂质量（P=0.0001）更明显。IgG4-ROD 患者的上下睑板腺缺失（P=0.001 和.0003）和泪膜破裂时间（NIBUT）（P=0.0001）更高。非侵入性泪膜破裂时间（NIBUT）（P=0.0166）和 Schirmer 试验结果（P=0.0243）较低。上睑板腺缺失（r=0.336，P=0.0140）和 NIBUT（r=-0.293，P=0.0497）与 IgG4-ROD 发病年龄呈正相关和负相关。眼外器官受累的数量与 Schirmer 试验呈负相关（r=-0.341，P=0.0167）。与 IgG4-ROD 患者的泪腺肿大相比，NIBUT 较低（P<.0001）。