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Ophthalmic manifestations and visual outcomes of granulomatosis with polyangiitis: a retrospective multicentre study in Korea

Eye volume 37, pages 1302–1307 (2023)Cite this article

Subjects

Abstract

Objectives

To analyse the ophthalmic manifestations and treatment outcomes of Korean patients with granulomatosis with polyangiitis (GPA).

Methods

One hundred twenty patients diagnosed with GPA by rheumatologists from January 1984 to March 2019 at three referral centres were retrospectively reviewed. Patients with ophthalmic symptoms were examined by ophthalmologists and underwent orbital imaging. Ophthalmic manifestations were divided into ocular involvement and ocular adnexal involvement. Multivariable logistic regression was used to examine the factors related to ocular, ocular adnexal, and optic nerve involvement. Visual improvement was defined as a best-corrected visual acuity gain of ≥2 Snellen lines, accompanied by improvements in optic nerve function.

Results

Ophthalmic manifestations were observed in 50 patients (41.7%) during the median follow-up period of 6.7 years. Proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA) positivity (odds ratio 3.19, 95% confidence interval 1.18–8.60) was an independent risk factor for ocular involvement, while sinonasal involvement (21.94, 2.54–189.69) and brain involvement (5.38, 1.50–19.31) were independent risk factors for ocular adnexal involvement. Antinuclear antibody (ANA) positivity was associated with optic nerve involvement (12.8, 1.80–90.5). Visual improvement occurred in 5 of 14 patients with optic nerve involvement, all of whom received intravenous (IV) immunosuppressive treatments beyond oral steroids within 2 months of visual impairment.

Conclusions

Ophthalmic involvement is common in Korean GPA patients and should be considered in the presence of PR3-ANCA, sinonasal or brain involvement. Patients with positive ANA have an increased risk of optic nerve involvement, and early IV immunosuppressive treatments beyond oral steroids are necessary to improve the visual outcome.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Min Kyu Yang

  2. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

    Hye Won Kim & Eun Ha Kang

  3. Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

    Namju Kim

  4. Department of Ophthalmology, Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul, Korea

    Hokyung Choung

  5. Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea

    Sang In Khwarg

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Contributions

MKY collected the data and wrote the paper. EHK, HC designed the study. HWK, EHK, NK, HC, SIK recruited the subjects. EHK, HC, SIK revised the manuscript and approved the final version of manuscript.

Corresponding author

Correspondence to Hokyung Choung.

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The authors declare no competing interests.

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Institutional review board approval was obtained, and the study was performed in accordance with the principles of the Declaration of Helsinki.

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Yang, M.K., Kim, H.W., Kang, E.H. et al. Ophthalmic manifestations and visual outcomes of granulomatosis with polyangiitis: a retrospective multicentre study in Korea. Eye 37, 1302–1307 (2023). https://doi.org/10.1038/s41433-022-02114-2

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