Cytological ocular surface changes in GVHD patients

Abstract

Abstract: : Purpose: to evaluate conjunctival goblet cell number and ICAM1 expression in GVHD patients, and to correlate them with clinical parameters of the disease. Methods: seven patients with ocular GVHD (4 M, 3 F, mean age 39.1±16 ys; mean duration of disease 36±17.3 months) and five age–matched normal controls were recruited for the study. Clinical examination included: medical history, evaluation of ocular signs and symptoms (scored from 0–3), visual acuity, Schirmer test type I and break–up time (BUT). The patients were also divided into two groups (group 1= mild clinical severity; group 2= moderate–severe) on the basis of the clinical evaluation. Impression cytology samples were collected from the nasal and inferior bulbar conjunctiva. Goblet cells were counted in three randomly selected fields and averaged. Immunofluorescent staining for ICAM1 was carried out and scored (from 0–4) on the basis of the markers’ expression. Spearman rho and Mann–Whitney U–tests were used as statistical analyses and a p<0.05 was considered statistically significant. Results: The ocular signs and symptoms of our GVHD patients were compatible with a dry eye–like syndrome. Schirmer test type I and BUT were reduced (4.8±6.7 mm/5min and 4.5±2.9 seconds, respectively). Goblet cells were significantly reduced in GVHD eyes with respect to normal eyes (65±30.5 and 192±16.9 cells/field respectively; p=0.021). The reduction was significantly greater in moderate–severe patients than in mild patients (p=0.009). Goblet cell number was also significantly correlated with Schirmer test values (p=0.002, rho=0.759). ICAM1 expression was increased in GVHD eyes with respect to normal controls (p=0.042). ICAM1 expression was significantly higher in moderate–severe patients than in mild patients (p=0.045), and inversely related to Schirmer test values (p=0.017, rho=–0.726). Conclusions: Ocular surface changes in GVHD are consistent with a dry eye disease. The severity of the disease is associated with tear parameters, goblet cell decrease and inflammatory markers, such as ICAM1.

Keywords: cornea: tears/tear film/dry eye • conjunctiva • autoimmune disease