Ocular adnexal IgG4-related disease: clinical features, outcome, and factors associated with response to systemic steroids.
OBJECTIVE
The aim of this study was to investigate clinical characteristics, outcome, and factors associated with response to systemic administration of steroids in patients with ocular adnexal immunoglobulin G4 (IgG4)-related disease.


METHODS
This was a retrospective evaluation of 11 patients with histopathologically verified ocular adnexal IgG4-related diseases at a medical center in Taiwan between January 2006 and December 2012. Clinical features and outcome, including serial change of serum IgG4 and clinical factors related to response to steroids systemically were evaluated.


RESULTS
Seven men and four women, mean age 54.5 years and mean follow-up of 33.5 months, were evaluated. Elevated serum IgG4 levels (>135 mg/dl) were observed in ten patients (91%). Lacrimal gland involvement was noted in eight (72.7%), followed by orbit, extraocular muscles, and eyelids. Seven patients (63.6%) had bilateral ocular lesions and eight (72.7%) had extraorbital involvement. Eight of ten patients who underwent systemic steroid treatment responded well in the early phase. Recurrence developed in five patients (45%), requiring repeat steroid therapy and adjunctive treatment. Median serum levels of IgG4 reduced from 540 to 101 mg/dl in ten patients after systemic corticosteroid administration. Patients with lower serum IgG4 and IgG4:IgG ratio at diagnosis were associated with poor response (p = 0.037).


CONCLUSIONS
Ocular adnexal IgG4-related disease predominantly involved the lacrimal glands bilaterally and was usually associated with high serum IgG4 levels and multiple organ involvement. Most patients responded well to steroid therapy, which was accompanied by a marked decrease in serum IgG4.
Department of Ophthalmology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan.
Wei-Kuang
WK
Yu
Shu-Ching
SC
Kao
Ching-Fen
CF
Yang
Fenq-Lih
FL
Lee
Chieh-Chih
CC
Tsai
D000328:Adult; D000368:Aged; D005141:Eyelid Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D008297:Male; D008875:Middle Aged; D008882:Mikulicz' Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D009135:Muscular Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D009801:Oculomotor Muscles / Q000473:pathology*; D016727:Orbital Pseudotumor / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D011239:Prednisolone / Q000627:therapeutic use; D012189:Retrospective Studies; D055815:Young Adult
D005938:Glucocorticoids; D007074:Immunoglobulin G; D011239:Prednisolone