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Y. Wang, Y. Ogawa, M. Dogru, Y. Tatematsu, M. Uchino, S. Okamoto, K. Tsubota; Characteristics of the Tear Functions and Ocular Surface in Patients With Chronic Graft-Versus-Host Disease Related Dry Eye Disease. Invest. Ophthalmol. Vis. Sci. 2007;48(13):433.
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To evaluate the ocular surface and tear function alterations in patients with chronic graft-versus-host disease (cGVHD) related mild and severe dry eye disease and compare the results with healthy controls and post-allogeneic hematopoietic cell transplantation (HCT) patients without dry eye.
Fifty eyes of 25 post-HCT patients were enrolled in this study. Included were 20 eyes of 10 patients with cGVHD related severe dry eye, 20 eyes of 10 patients with cGVHD related mild dry eye and 10 eyes of 5 patients without dry eye. Twenty-eight eyes of 14 age-matched healthy subjects were also recruited. Clinical examination included tear evaporation rate, the degree of meibomian gland (MG) obstruction, corneal sensitivity (CS), Schirmer test, tear break-up time (BUT), and fluorescein and Rose Bengal staining. Conjunctival impression cytology and brush cytology specimens were collected to evaluate the alterations in goblet cell density (GCD), squamous metaplasia, and the numbers of inflammatory cells. Informed consent and ethic board reviews were obtained.
In post-HCT patients, MG obstruction (grade>1) was noted in 40 of 50 eyes, and significantly decreased CS was found compared to normal controls (p=0.004). Severe dry eye patients showed enhanced tear evaporation rate, decreased conjunctival GCD, increased conjunctival squamous metaplasia and inflammatory cell numbers compared to normal controls and post-HCT without dry eye subjects (p<0.001). Mild dry eye patients presented with significantly decreased conjunctival GCD and inflammatory cell number compared to normal controls and post-HCT without dry eye subjects (p<0.001). The duration of onset of dry eye was significantly shorter and the conjunctival inflammatory cell numbers were statistically higher in cGVHD related severe dry eye patients compared to mild dry eye patients (p=0.03). Tear evaporation, GCD, and MG disease were worse in severe dry eye patients compared to patients with mild dry eyes.
The extent of the inflammotary process seems to play a pivotal role in the outcome of cGVHD related dry eye disease with changes in tear evaporation, CS and GCD acting as determinants of the differences of the ocular surface healty status.
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