Supplementary Material for: Ocular Abnormalities in Patients with Vitiligo: A Systematic Review and Meta-Analysis

<b><i>Background:</i></b> Vitiligo is a skin depigmentation disorder that results from the autoimmune destruction of cutaneous melanocytes. Several ocular abnormalities, including uveitis, dry eye, glaucoma, and retinal diseases, have been reported in patients with vitiligo. The aim of our study was to investigate the association of ocular abnormalities with vitiligo. <b><i>Methods:</i></b> This meta-analysis was registered in PROSPERO (CRD42021224167) and adhered to MOOSE checklist and PRISMA guidance for all processes. PubMed, Embase, Web of Science, and Cochrane databases were searched for studies examining the association between ocular abnormalities and vitiligo from inception to December 10, 2020. Studies recruiting patients with Sjogren’s syndrome or Vogt-Koyanagi-Harada syndrome were excluded. The primary outcomes were the Schirmer test, tear film break-up time (TBUT), and ocular surface disease index (OSDI) of vitiligo patients compared to the controls. The risk of bias of the selected studies was assessed using the Newcastle-Ottawa Scale (NOS) of case-control studies. <b><i>Results:</i></b> This meta-analysis of 16 case-control studies showed that patients with vitiligo had significantly lower Schirmer test values (mean difference [MD], −1.65; 95% CI, −2.81 to −0.49), shorter TBUTs (MD, −4.66; 95% CI, −7.05 to −2.26), higher ocular surface disease indices (MD, 18.02; 95% CI, 5.7–30.35), and thinner subfoveal choroidal thicknesses (MD, −53.10; 95% CI, −69.84 to −36.36). No significant differences were found in the prevalence of glaucoma and the level of intraocular pressure. <b><i>Conclusions:</i></b> Our study supports an association between dry eye and thinner subfoveal choroidal thickness in patients with vitiligo. Dermatologists should be aware of these possible comorbidities and refer vitiligo patients with ocular symptoms to ophthalmologists for further management.

<b><i>背景：</i></b> 白癜风（vitiligo）是一种因自身免疫破坏皮肤黑素细胞而引发的皮肤色素脱失性疾病。已有多项研究报道，白癜风患者可合并多种眼部异常，包括葡萄膜炎（uveitis）、干眼症（dry eye）、青光眼（glaucoma）以及视网膜疾病（retinal diseases）。本研究旨在探讨眼部异常与白癜风之间的关联。<b><i>方法：</i></b> 本项荟萃分析已在PROSPERO平台注册（CRD42021224167），全程遵循MOOSE清单与PRISMA指南。检索了PubMed、Embase、Web of Science及Cochrane数据库，检索时限为建库至2020年12月10日，筛选探讨眼部异常与白癜风关联的相关研究。排除纳入干燥综合征（Sjogren’s syndrome）或伏格特-小柳-原田综合征（Vogt-Koyanagi-Harada syndrome）患者的文献。主要结局指标为：与对照组相比，白癜风患者的施墨试验（Schirmer test）结果、泪膜破裂时间（tear film break-up time, TBUT）以及眼表疾病指数（ocular surface disease index, OSDI）。采用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale, NOS）评估纳入研究的偏倚风险。<b><i>结果：</i></b> 本项纳入16项病例对照研究的荟萃分析结果显示，白癜风患者的施墨试验值显著更低（均数差[MD] = -1.65；95%置信区间[CI]：-2.81至-0.49），泪膜破裂时间显著更短（MD = -4.66；95%CI：-7.05至-2.26），眼表疾病指数显著更高（MD = 18.02；95%CI：5.7至30.35），且中心凹下脉络膜厚度（subfoveal choroidal thickness）显著更薄（MD = -53.10；95%CI：-69.84至-36.36）。未发现两组在青光眼患病率与眼内压（intraocular pressure）水平上存在显著差异。<b><i>结论：</i></b> 本研究证实白癜风患者可合并干眼症及中心凹下脉络膜厚度降低的眼部异常。皮肤科医师应警惕此类共病，对伴有眼部症状的白癜风患者，应转诊至眼科医师处接受进一步诊疗。