Postoperative outcomes of biopsy versus debulking surgery for immunoglobulin G4-related ophthalmic disease: a retrospective comparative study.

Purpose: To compare the postoperative outcomes of corticosteroid therapy following biopsy with those following debulking surgery in patients with immunoglobulin G4 (IgG4)-related ophthalmic disease (IgG4-ROD).

Study design: Retrospective comparative study.

Methods: Fifteen patients diagnosed with IgG4-ROD (5 unilateral, 10 bilateral) were retrospectively analyzed. IgG4-ROD was diagnosed based on imaging, histopathology, and blood test results. The biopsy group included patients who underwent resection of minimal tissue for diagnosis, whereas the debulking group included patients who underwent resection of a substantial portion of the mass to decrease the tumor size. Postoperative outcomes after steroid administration, recurrence rates, and changes in lacrimal gland function were compared between the groups.

Results: The biopsy and debulking groups included seven and eight patients, respectively. All patients in the biopsy group and 25% of patients in the debulking group required steroid treatment postoperatively (p = 0.0070). Relapse occurred in 71.4% and 12.5% (p = 0.041) and maintenance therapy was required in 57.1% and 12.5% (p = 0.12) patients in the biopsy and debulking groups, respectively. Twelve patients had extraorbital lesions, with one patient receiving corticosteroid treatment for sphenoid bone lesion. Schirmer I test values did not differ preoperatively and postoperatively in either group (biopsy: p = 0.47; debulking: p = 0.72). One patient from the biopsy group developed severe dry eyes, necessitating lacrimal canalicular excision.

Conclusions: Debulking surgery effectively reduced the requirement for postoperative steroid administration for recurrent lacrimal gland lesion in patients with IgG4-ROD, indicating its potential as an effective alternative to current standard treatment.