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Marc Schargus, Julia Menrath, Goetz U. Grigoleit, Gerd Geerling; Correlation Of Tear Film Osmolarity And Graft Versus Host Disease (GvHD) Score In Patients With Haematopoietic Stem Cell Transplantation. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3793.
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Dry eye has become recognised as a major symptom of chronic Graft versus Host Disease (GvHD) in patients with Haematopoietic stem cell transplantation (SCT) with a significant impact on quality of life, although it is not life threatening. Nearly 60% of the SCT patients develop dry eye symptoms. Tear film osmolarity has been heralded as a new diagnostic tool with improved sensitivity and specificity in the diagnosis of dry eye. Aim of this study was to evaluate if tear film osmolarity can be used as reliable diagnostic tool in dry eye and GvHD.
From February 2009 to November 2010 a group of 121 patients after SCT (1-25 months after SCT) were examined. GvHD was scored regarding the Glucksberg GvHD Score into 4 stages (0=no GVHD,1-3). The following dry eye tests were performed: Tear Film Osmolarity (Tearlab®), Schirmer test, Ocular surface Disease Index (OSDI), corneal Fluorescein and conjunctival Lissamin green staining. In addition the morphology and function of the Meibomian glands was also graded. A dry eye severity score (DESS) was calculated using a normalized scale for all test parameters (0 to 1.0 = no dry eye to maximum severity of dry eye). ANOVA test was used for statistics.
A significant correlation was found between GvHD Score and Tear Film Osmolarity using the values of the first measured eye (p=0,016). Using the osmolarity test values from the second tested eye revealed a lower significant correlation (p=0,044). There was also a highly significant correlation between GvHD Score and DESS (p=0,001). There was only low or no significant correlation between the other dry eye test parameters and GvHD score and DESS.
GvHD score does correlate with Tear film osmolarity and DESS. The new tear film osmolarity measurement is fast and easy to perform even for non ophthalmologists. Calculating the DESS is much more complex than measurement of Tear Film Osmolarity. Hence, osmolarity seems to be a new appropriate component in the diagnosis or monitoring dry eye symptoms in and before GvHD after SCT.
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