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Alexander Gan, Claudia Prospero Ponce, Andrew Quinn, Patricia Chevez-Barrios, Alice Chuang, Richard Yee; Zone A (ZA), Posterior Lid Margin Vascularization: An Early Sign of Ocular Surface Disease (OSD). Invest. Ophthalmol. Vis. Sci. 2013;54(15):968.
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© ARVO (1962-2015); The Authors (2016-present)
To analyze the histologic, clinical, and morphological characteristics of the avascular zone of the inferior posterior lid margin and its possible clinical significance as a sign of early and late chronic inflammation in OSD.
Retrospective chart review of the OSD findings and the Ocular Surface Disease Index (OSDI) questionnaire were performed in 49 patients(pts), >20 yrs old seen in a tertiary care center. Inclusion criteria: pts with a complete ocular surface evaluation including anterior blepharitis(AB), vascularization(V) of the inferior lid margin, meibomian gland obstruction(O) and turbidity(T). Basal tear test(BTT) and lissamine green staining(LGS) and quantification of the ZA was graded based on the degree of V noted on the everted posterior inferior lid margin. Exclusion criteria: previous surgery or on topical anti-inflammatory treatment. OSDI scores were divided into 2 groups (normal:≤12vs dry eye:>12), ZA was divided into 2 groups normal and severe and were compared to OSD signs using chi2test. Lower lid biopsy was obtained for histology.
Forty-nine charts were reviewed and analyzed, 14 patients had normal OSDI and 35 had dry eye OSDI. There was no significant statistical difference between OSDI groups and all OSD findings [AB,p=0.08;V,p=0.8;O,p=0.05;T,p=0.7;ZA,p=0.7(77.1%dry eye OSDI vs 85.7% normal OSDI). LGs and BTT were not statistically different between the two OSDI groups (p>0.5, p>0.1). Comparing the ZA groups, 10 pts had normal grading, 39 pts had severe grading. No significant statistical differences were found between ZA groups and OSD findings (AB,p=0.6;V,p=0.2;O,p=0.9;T, p=1.0). LGS and BTT were not statistically different between the ZA group. Patients with severe ZA grading were found to have normal-mild OSD findings (AB=84.2%, V=82.1%, O=56.4%, T= 32.4%), in contrast to patients with severe ZA grading that had severe OSD (AB=15.8%,V=18.0%,O=43.6%,T=67.6%). Histology showed inflammatory response and increased number of dilated vessels in the posterior lid margin.
The OSDI questionnaire did not correlate with any OSD clinical signs. ZA grading was noted to be severe even in our cohort with mild disease. ZA vascularization may be a helpful clinical sign of early OSD.
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