H.H.OO1, M.Y.D.CHOY1, R.AGRAWAL2
MOH Holdings Pte Ltd (MOHH)1, Tan Tock Seng Hospital2
Ocular involvement in Immunoglobulin A Nephropathy (IgAN) is uncommon. We aim to review the ocular manifestations reported in patients with IgAN, including two cases from our institution.
We reviewed 48 reported cases of ocular manifestations in patients with IgAN published on Pubmed. Two cases from our institution are as follows: (1) a 57-year-old female with IgAN for 15 years presented with bilateral acute sclerouveitis, which responded to oral non-steroidal anti-inflammatory drugs (NSAIDs) and topical corticosteroids, (2) a 54-year-old female with IgAN for 14 years presented with unilateral anterior scleritis, which resolved with topical and oral corticosteroids. Both patients had no recurrence after approximately one year.
The most common ocular manifestations are episcleritis (27.1%), scleritis (14.6%), uveitis (16.7%) and hypertensive retinopathy (14.6%). Other rare manifestations include myasthenia gravis (8.3%), Vogt-Koyanagi-Harada syndrome (6.3%), serous retinal detachment (4.2%), drusenoid deposits (4.2%) and others (4.2%). The median age at presentation was 39 years old and 52.1% were female. 58.3% had prior history of IgAN before ocular presentation while 31.3% were diagnosed with IgAN after ocular presentation. An average disease duration prior to ocular presentation was 110.1 months. 37.4% had chronic kidney disease stage 3 and above. Most patients showed good clinical response to systemic corticosteroids and/or immunosuppression.
Ocular manifestations in IgAN could either be immunogenic or secondary to systemic complications such as hypertension. A routine urinalysis should be included in the baseline autoimmune workup for ocular inflammatory conditions. Multi-disciplinary management with nephrologist, and systemic corticosteroids and immunosuppression may help to reduce disease morbidity.