American journal of ophthalmology · 2025
Anti-Acetylcholine Receptor Antibodies in Tear for the Diagnosis of Ocular Myasthenia Gravis.
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Lu Cheng, Yang Yuanting, Dong Yuying, Tang Ting, Chen Jian, Wang Yingwei, Wu Zheng, Zhou Qing
Аннотация
BACKGROUND AND OBJECTIVE: Ocular myasthenia gravis (OMG) significantly affects patients' quality of life. However, conventional serum assays often fail to detect anti-acetylcholine receptor (AChR) antibodies in more than half of OMG cases, complicating accurate diagnosis. Given the immunological role of tears in the ocular environment, they may serve as a viable alternative for antibody detection. This study investigates the utility of tear-based anti-AChR antibody detection as a diagnostic tool for OMG and compares its performance with that of serum-based cell-based assays (CBAs).
DESIGN: Prospective diagnostic testing validity evaluation.
METHODS: A total of 65 participants were enrolled, including 52 patients diagnosed with OMG and 13 healthy controls. Anti-AChR antibodies were assessed in both serum and tear samples using CBAs. Diagnostic performance metrics were compared between the 2 sample types, and correlations between antibody levels and clinical severity were analyzed.
RESULTS: Tear-based CBA demonstrated significantly superior diagnostic accuracy (AUC = 0.926, P < .0001) compared to serum-based CBA (AUC = 0.656, P = .0836). The sensitivity of tear CBA was 80.8% (95% CI: 68.1%-89.2%), markedly higher than that of serum CBA at 42.3% (95% CI: 29.9%-55.8%). Among the 42 seronegative OMG patients, 83.3% tested positive using tear CBA, whereas only 40.5% were positive via serum CBA (P < .0001). Notably, tear anti-AChR antibody levels did not show a consistent correlation with symptom severity.
CONCLUSIONS: Tear-based detection of anti-AChR antibodies offers a non-invasive, highly sensitive diagnostic approach for OMG, particularly beneficial in cases where serum tests are negative. This method holds promise for improving early diagnosis and clinical decision-making in OMG management.
DESIGN: Prospective diagnostic testing validity evaluation.
METHODS: A total of 65 participants were enrolled, including 52 patients diagnosed with OMG and 13 healthy controls. Anti-AChR antibodies were assessed in both serum and tear samples using CBAs. Diagnostic performance metrics were compared between the 2 sample types, and correlations between antibody levels and clinical severity were analyzed.
RESULTS: Tear-based CBA demonstrated significantly superior diagnostic accuracy (AUC = 0.926, P < .0001) compared to serum-based CBA (AUC = 0.656, P = .0836). The sensitivity of tear CBA was 80.8% (95% CI: 68.1%-89.2%), markedly higher than that of serum CBA at 42.3% (95% CI: 29.9%-55.8%). Among the 42 seronegative OMG patients, 83.3% tested positive using tear CBA, whereas only 40.5% were positive via serum CBA (P < .0001). Notably, tear anti-AChR antibody levels did not show a consistent correlation with symptom severity.
CONCLUSIONS: Tear-based detection of anti-AChR antibodies offers a non-invasive, highly sensitive diagnostic approach for OMG, particularly beneficial in cases where serum tests are negative. This method holds promise for improving early diagnosis and clinical decision-making in OMG management.