Ocular Manifestations in ANCA-Associated Vasculitis

Ocular manifestations affect nearly a quarter of patients with antineutrophil cytoplasm antibody (ANCA)-associated vasculitis, according to a retrospective analysis published in the journal Rheumatology.

“There are published data on ocular manifestations of granulomatosis with polyangiitis (GPA), but few for eosinophilic granulomatosis with polyangiitis (EGPA) or microscopic polyangiitis (MPA),” explained corresponding author Mats L. Junek, MD, of McMaster University, Hamilton, Ontario, Canada, and coauthors in the study background. “There is little information concerning chronicity, complications, and association with other cranial manifestations of ANCA-associated vasculitis.”

To help fill the gaps, the study analyzed data for 1441 patients with ANCA-associated vasculitis between 2006 and 2022. Among them, 395 patients had EGPA, 876 patients had GPA, and 170 patients had MPA.

Ocular manifestations were documented for 23.1% of patients with ANCA-associated vasculitis overall. The rate was 9.9% among patients with EGPA, 32.7% with GPA, and 7.1% with MPA at any time over the course of the disease. However, ocular manifestations were present more often at disease onset than during follow-up, according to the study.

Conjunctivitis/episcleritis and scleritis were the most common disease-related manifestations. Multivariable analysis across disease manifestations found dacryocystitis, lacrimal duct obstruction, and retro-orbital disease were associated with sinonasal manifestations of GPA, and ocular manifestations were linked with hearing loss in patients with MPA.

Cataracts and visual impairment were the 2 most frequent ocular complications of disease.

“Ocular manifestations occur in all forms of ANCA-associated vasculitis, especially in GPA,” researchers wrote. “Clinicians should be mindful of the wide spectrum of ocular disease in ANCA-associated vasculitis, caused by active vasculitis, disease-associated damage, and toxicities of therapy.”

Reference
Junek ML, Zhao L, Garner S, et al. Ocular manifestations of ANCA-associated vasculitis. Rheumatology. 2023;62(7):2517-2524. doi:10.1093/rheumatology/keac663