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Alexandra Knoll, Eva Jakob, Karin Brandauer, Bianca Dobner, Ute Hegenbart, Peter Dreger, Gerd Auffarth, Friederike Mackensen; Behaviour of Conjunctival Goblet Cells after allogenic Hematopoietic Stem Cell Transplantation. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5422.
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© ARVO (1962-2015); The Authors (2016-present)
The ocular Graft-versus-Host-Disease (oGvHD) is a frequent sequelae after hematopoietic stem cell transplantation (HSCT). We hypothesized that a decrease of goblet cells in the conjunctival epithelium can serve as predictive marker for an emerging oGvHD. To assess goblet cell density we compared the more invasive impression cytology (IC) with the less invasive in vivo confocal microscopy (IVCM) (Figure A,B).
Patients who were listed for HSCT were examined before and 100 days after the transplantation. The examination included a questionnaire, slit lamp examination, Schirmer Test II, impression cytology and confocal microscopy of the conjunctiva with the Heidelberg Retina Tomograph with the Rostock Cornea Modul attachment (HRT-RCM). At least three specimen/pictures of each patient were assessed for goblet cell density and means were calculated. The Approval of the Ethical Review Board Heidelberg and informed consent was obtained.
44 patients were included (mean age 56 years). 18 patients were not re-examined after HSCT (4 died, 2 were pre final, 2 were not transplanted, 10 repeatedly cancelled their follow-up examination due to poor health). Mean time to follow-up examination was 147 days after HSCT. Goblet cell density before and after HSCT of all patients with evaluable pre-and post HSCT -examination was 52.6±7.5 vs. 43.9±4.1 cells/mm2 (Mean±SEM, p=0.46, n=8, wilcoxon’s signed rank) assessed with IC and 62.7±3.4 vs. 61.6 ±4.3 cells/mm2 (p=0.8, n=24) assessed with IVCM. 8 healthy subjects were examined via IVCM as control (mean age 38 years), mean goblet cell density was 74.8±4.3 cells/mm2.
IVCM showed goblet cell numbers in similar magnitude to the standard method IC, we therefore conclude that IVCM can also reliably be used. Conjunctival goblet cells did not show a significant decrease after HSCT. The time interval to follow-up examination may have been too short as most patients still were on immunosuppressants and only 2 had signs of oGvHD. Patients who present with oGvHD symptoms will be re-examined for goblet cell density in our clinic.
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