University of Arizona College of Medicine-Phoenix, United States; Department of Ophthalmology, Mayo Clinic Arizona, United States.
Division of Health Sciences Research, Mayo Clinic Arizona, United States.
Ocul Surf. 2017 Oct;15(4):784-788. doi: 10.1016/j.jtos.2017.08.002. Epub 2017 Aug 5.
Dry eye symptoms greatly impact patients' quality of life in ocular graft-versus-host disease (oGVHD). Various ocular surface changes have been reported in oGVHD, including meibomian gland atrophy (MGA) and clinical conjunctival scarring or subepithelial fibrosis (CSEF). The relationships between CSEF, MGA, and other ocular surface changes in oGVHD were examined.
Charts of 21 consecutive GVHD patients examined by a single ophthalmologist were retrospectively reviewed. International Chronic Ocular Graft-vs-Host-Disease Consensus Group (ICCG) scores were calculated for each patient using previously published methods. The severity of CSEF by slit lamp examination and MGA by infrared meibography were also assessed for each patient. Infrared meibography images were analyzed using ImageJ to determine percent of MGA. Pearson correlation coefficients were calculated using SAS Studio 9.3 (SAS Institute, Cary, NC).
In the 42 eyes, no significant correlations were identified among the variables examined (CSEF score, ICCG score, MGA). Further examination revealed asymmetric ocular findings in 20 of 21 patients. Analysis of the more severe eye alone (n = 21) revealed a weakly positive correlation between ICCG score and CSEF (r = 0.54; p = 0.01). No other statistically significant correlations were found.
Clinical CSEF may be an important sign of GVHD impact on the ocular surface and may be relevant in oGVHD severity assessment. Though meibomian glands and conjunctiva are in close proximity, MGA did not correlate with clinical CSEF findings. Some ocular GVHD patients may present with asymmetrical ocular findings, with one eye displaying more severe pathological changes and symptoms despite the systemic nature of GHVD. Further studies are needed to examine these findings.
干眼症症状严重影响眼部移植物抗宿主病（oGVHD）患者的生活质量。oGVHD 患者出现多种眼表变化，包括睑板腺萎缩（MGA）和临床结膜瘢痕或上皮下纤维化（CSEF）。本研究旨在探讨 oGVHD 中 CSEF、MGA 与其他眼表变化的关系。
回顾性分析 21 例经同一位眼科医生检查的 GVHD 患者的病历。采用先前发表的方法，根据国际慢性眼部移植物抗宿主病共识组（ICCG）评分计算每位患者的 ICCG 评分。通过裂隙灯检查评估每位患者的 CSEF 严重程度，并通过红外睑板腺照相术评估 MGA 的严重程度。使用 ImageJ 分析红外睑板腺照相术图像，以确定 MGA 的百分比。使用 SAS Studio 9.3（SAS Institute，Cary，NC）计算 Pearson 相关系数。
在 42 只眼中，未发现所检查变量之间存在显著相关性（CSEF 评分、ICCG 评分、MGA）。进一步检查发现，21 例患者中有 20 例存在不对称的眼部表现。单独分析更严重的眼睛（n=21），发现 ICCG 评分与 CSEF 呈弱正相关（r=0.54；p=0.01）。未发现其他具有统计学意义的相关性。
临床 CSEF 可能是 GVHD 对眼表影响的重要标志，在 oGVHD 严重程度评估中可能具有相关性。尽管睑板腺和结膜毗邻，但 MGA 与临床 CSEF 检查结果无关。一些眼部 GVHD 患者可能表现出不对称的眼部表现，尽管 GVHD 具有全身性，但一只眼的病理改变和症状更严重。需要进一步研究来检验这些发现。
