Giannaccare Giuseppe, Bonifazi Francesca, Sebastiani Stefano, Sessa Mariarosaria, Pellegrini Marco, Arpinati Mario, Moscardelli Fabiana, Versura Piera, Campos Emilio
Ophthalmology Unit, Alma Mater Studiorum University of Bologna, DIMES, S.Orsola-Malpighi University Hospital, Bologna, Italy.
Haematology Institute "L.A. Seragnoli," Alma Mater Studiorum University of Bologna, DIMES, S.Orsola-Malpighi University Hospital, Bologna, Italy.
Cornea. 2018 Oct;37(10):1264-1269. doi: 10.1097/ICO.0000000000001585.
To perform qualitative and quantitative analysis of meibomian gland (MG) dropout in hematological patients before hematopoietic stem cell transplantation (HSCT) and to correlate it with both ocular surface and hematological characteristics.
This prospective study included 46 consecutive patients undergoing HSCT and 30 age- and sex-matched healthy controls. Noninvasive meibography of the lower eyelid, meiboscore (Pult scale), Schirmer test type I, tear film breakup time, and corneal and conjunctival staining were measured. Subjective symptoms were scored by the Ocular Surface Disease Index. The dry eye diagnosis was ascertained according to TFOS DEWS II Criteria. Hematological data included diagnosis (acute leukemias vs. other malignancies), stage of the disease, time from diagnosis to ophthalmological examination, and previous therapy (chemotherapy, radiotherapy, or autograft).
Hematological patients presented a significantly lower tear film breakup time and a higher meiboscore compared with controls (respectively 4.8 ± 3.0 seconds vs. 11.0 ± 3.0 and 2.0 ± 1.1 vs. 0.9 ± 0.4; P < 0.001). Conversely, other parameters did not differ between both groups. Dry eye was diagnosed in 14 out 46 hematological patients (30.4%). MG loss was significantly higher in hematological patients than in controls (29.8% ± 15.0% vs. 21.2 ± 13.0; P = 0.007) and was higher in the nasal third compared with both central and temporal thirds (respectively, 39.8% ± 21.4% vs. 18.5 ± 15.6 and 25.1 ± 18.3; P < 0.0001). The diagnosis of acute leukemia (β = 0.449; P = 0.003) and the history of previous chemotherapy (β = 0.444; P = 0.003) were associated with lower MG loss.
Hematological patients presented significantly reduced MG areas even before HSCT, particularly those affected by nonacute malignancies. The topographical pattern of MG dropout resembles that of conventional dry eye.
对造血干细胞移植（HSCT）前血液病患者的睑板腺（MG）缺失进行定性和定量分析，并将其与眼表及血液学特征相关联。
这项前瞻性研究纳入了46例连续接受HSCT的患者以及30例年龄和性别匹配的健康对照者。测量下眼睑的无创睑板腺造影、睑板腺评分（Pult量表）、I型泪液分泌试验、泪膜破裂时间以及角膜和结膜染色情况。通过眼表疾病指数对主观症状进行评分。根据TFOS DEWS II标准确定干眼诊断。血液学数据包括诊断（急性白血病与其他恶性肿瘤）、疾病分期、从诊断到眼科检查的时间以及既往治疗情况（化疗、放疗或自体移植）。
与对照组相比，血液病患者的泪膜破裂时间显著缩短，睑板腺评分更高（分别为4.8±3.0秒对11.0±3.0秒，以及2.0±1.1对0.9±0.4；P<0.001）。相反，两组间的其他参数无差异。46例血液病患者中有14例（30.4%）被诊断为干眼。血液病患者的睑板腺缺失显著高于对照组（29.8%±15.0%对21.2±13.0；P = 0.007），且鼻侧三分之一处的睑板腺缺失高于中央和颞侧三分之一处（分别为39.8%±21.4%对18.5±15.6和25.1±18.3；P<0.0001）。急性白血病的诊断（β = 0.449；P = 0.003）和既往化疗史（β = 0.444；P = 0.003）与较低的睑板腺缺失相关。
血液病患者即使在HSCT前睑板腺面积也显著减少，尤其是那些受非急性恶性肿瘤影响的患者。睑板腺缺失的地形学模式类似于传统干眼。
