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Yael Kusne, Joanne F Shen; Correlation of conjunctival subepithelial fibrosis and meibomian gland atrophy in chronic ocular GVHD. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5696. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Retrospective chart review examining severity of meibomian gland atrophy and its correlation with Ogawa score and conjunctival subepithelial fibrosis in chronic ocular GVHD patients.
13 subjects with ocular GVHD were evaluated with OSDI, conjunctival injection severity, corneal fluorescein vital dye staining, Schirmer’s testing without anesthesia, severity of conjunctival subepithelial fibrosis (CSEF) and meibomian gland atrophy (MGA) by infrared meibography. Ogawa scores were calculated for each patient using criteria previously published (Ogawa, 2013). Infrared meibography images were scored using ImageJ to determine percent of MGA. Pearson correlation coefficients were calculated.
Of the 13 patients in our study, the range of Ogawa scores in the study was from 4-10 points, and the range of MGA was from 20% to 95%. MGA statistically correlated with degree of CSEF (r=0.60, p=0.02). Ogawa scores were not statistically correlated with percent of meibomian atrophy (r=0.22, p=0.23).
Ocular GVHD patients with severe dry eye symptoms often have CSEF of the palpebral conjunctiva. Expectedly, these patients have mucin deficiency from conjunctival damage. In addition, meibography demonstrates loss of meibomian glands in these severe ocular GVHD patients. Meibomian gland destruction has been previously reported in ocular GVHD by Ogawa et al in 2013. The Ogawa scoring system is used as a method to assess severity of ocular GVHD using conjunctival injection, corneal fluorescein vital dye staining, Schirmer’s testing, and OSDI score. However, this score does not account MGA. This study demonstrates correlation of findings of MGA with CSEF. This correlation may explain why patient with both MGA and CSEF have severe symptoms of dry eye, especially if aqueous tear production is low, affecting 3 major contributors to the tear film. Since meibography is not universally available, adding a score for degree of CSEF may increase the specificity of Ogawa scoring system for ocular GVHD. Future prospective meibography studies of pre-stem cell transplant patients will help determine the etiology of these ocular findings.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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