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Vitiligo, a depigmenting skin condition caused by melanocyte loss, has been long suspected to be associated with autoimmune disease but has proven elusive to establish as having a direct causal link given confounding and reverse causality. To overcome the above limitations, the researchers utilized Mendelian randomization (MR), a methodology that utilizes genetic variants as surrogates to ascertain causality between traits, to investigate the relationships between vitiligo and six common autoimmune diseases such as systemic lupus erythematosus, Graves’ disease, inflammatory bowel disease, AA, T1DM, and RA.

Bidirectional two-sample MR analyses were applied in the study to examine possible bidirectional causal relationships between vitiligo and all the autoimmune diseases. SMR and colocalization tests were further applied to detect common genetic loci that would account for the shared risks. The genetic method generated strong evidence without the common bias present in observational investigations.

Key Findings

Bidirectional Causality Between Vitiligo and RA

• RA raises the risk of vitiligo: IVW OR = 1.19, 95% CI: 1.05–1.13, p = 0.008

• Vitiligo raises the risk of RA: IVW OR = 1.08, 95% CI: 1.03–1.13, p < 0.001

Vitiligo raises the risk of other autoimmune diseases:

• Alopecia Areata (AA): IVW OR = 1.14, 95% CI: 1.04–1.26, p = 0.008

• Type 1 Diabetes Mellitus (T1DM): IVW OR = 1.14, 95% CI: 1.06–1.23, p < 0.001

Genetic loci shared:

SMR and colocalization tests identified three shared genes between RA and vitiligo:

• FCRL3 (Fc Receptor-Like 3)

• FADS1 (Fatty Acid Desaturase 1)

• FADS2 (Fatty Acid Desaturase 2)

These could potentially function as future therapeutic or diagnostic targets, indicating a common autoimmune mechanism.

This study presents genetic evidence that vitiligo is causally linked with RA, T1DM, and AA, with reciprocal risk elevation particularly between vitiligo and RA. Shared susceptibility genes also strengthen the notion of shared autoimmune mechanisms and provide a new area for multi-disease treatment and drug development.

Reference:

Huang, J., Jiang, L., Hu, Y., Fu, C., Zhang, K., Wen, Y., Zhou, S., Huang, J., Chen, J., & Zeng, Q. (2025). Association of vitiligo with autoimmune disorders: A bidirectional two‐sample and summary‐based Mendelian randomization study. Journal of Cosmetic Dermatology, 24(6). https://doi.org/10.1111/jocd.70211

Reference:

Kumar S, Tarnow-Mordi W, Mol BW, et al. Intrapartum Sildenafil to Improve Perinatal Outcomes: A Randomized Clinical Trial. JAMA. 2025;334(2):149–159. doi:10.1001/jama.2025.7710

Keywords:

Sildenafil, Fails, Reduce, Adverse, Perinatal, Outcomes, Linked, Intrapartum, Hypoxia, JAMA, Kumar S, Tarnow-Mordi W, Mol BW

The report describes a 53-year-old man with ocular hypertension and a history of cataract surgery with intraocular lens (IOL) fixation who underwent PMS due to uncontrolled IOP. The patient also had a history of atopic dermatitis and prolonged use of potent topical steroids, factors suspected to compromise choroidal microcirculation and RPE integrity.

Initially, the surgery appeared successful, lowering IOP from 42 mmHg to 10 mmHg on the first postoperative day. However, within days, the patient developed ciliochoroidal detachment (CD), a known complication of glaucoma surgery under hypotonic conditions. Despite conservative management with atropine and topical steroids, the condition progressed. By one month post-surgery, the patient’s vision dropped to 20/500, and bullous serous retinal detachment involving the macula was noted. Imaging revealed extensive RPE tears in the inferior regions of the retina.

To prevent further deterioration, surgeons performed scleral drainage and pars plana vitrectomy with sulfur hexafluoride (SF6) gas tamponade. The procedure successfully elevated IOP and led to the resolution of the detachment. Postoperatively, the patient’s IOP stabilized in the mid-teens with no recurrence of SRD, though postoperative angiography confirmed the presence of window defects consistent with RPE tears.

According to the authors, the case emphasizes that not only absolute postoperative hypotony but also a rapid and significant drop in IOP can disturb choroidal blood flow and compromise RPE function, especially in eyes with structural vulnerabilities. The findings suggest that eyes with exfoliation syndrome, long-term steroid exposure, or pre-existing choroidal circulatory compromise may be particularly susceptible to such complications.

Previous reports of SRD and RPE tears have been associated with conventional glaucoma filtration surgeries, but until now, none have been linked to PMS. The authors propose that the dramatic pressure change, combined with a fragile RPE due to chronic steroid use and atopic dermatitis, likely triggered the sequence of CD, RPE tear, and SRD in this case.

The report highlights the importance of individualized surgical planning and vigilant postoperative monitoring in glaucoma patients, especially when risk factors for RPE fragility exist. Early recognition of choroidal detachment and prompt IOP-elevating interventions may be critical in preventing vision-threatening outcomes.

“The study emphasizes that while PMS is generally safe and effective, clinicians should be aware of this rare but serious complication. Further research is needed to better understand the underlying mechanisms and to establish preventive strategies for high-risk patients undergoing minimally invasive glaucoma surgery,” the authors concluded.

Reference:

Sadahide, A., Harada, Y., Sakaguchi, H. et al. Serous retinal detachment with retinal pigment epithelium tear after PreserFlo MicroShunt surgery: a case report. BMC Ophthalmol 25, 424 (2025). https://doi.org/10.1186/s12886-025-04259-6