Meibomian Gland Dropout in Hematological Patients Prior to Hematopoietic Stem Cell Transplantation

Abstract

Purpose : The evidence of ocular surface impairment in patients with hematological disorders already prior to hematopoietic stem cell transplantation (HSCT) is growing. The purpose of this study was to analyze meibomian gland dropout in these patients, and to correlate it with both ocular surface and hematological characteristics.

Methods : This prospective study included 46 patients undergoing HSCT and 30 age/sex matched healthy controls. Non-invasive meibography of the lower eyelid was performed by a slit lamp equipped with an infrared camera, and the images were analysed using the image editing software ImageJ. The percentage of meibomian gland loss was then calculated by two analyzers (PV and FM) and the average was used for the analysis. Meiboscore (Pult scale), Schirmer test I and tear film break-up time (BUT) were also performed; subjective symptoms were scored by ocular surface disease index (OSDI). Dry eye (DE) diagnosis was ascertained according to TFOS DEWS II Criteria. Hematological data included diagnosis (acute [myeloid and lymphoblastic leukaemias] versus other malignancies), stage of the disease (early, partial/complete remission, advanced), time from diagnosis to HSCT, previous therapy (chemo/radiotherapy, autograft).

Results : Among overall hematological patients, 27 were affected by acute diseases and 19 by other malignancies. Hematological patients presented significant lower BUT and higher meiboscore compared to control group (respectively 4.8±3.0 vs 11.0±3.0 and 2.0±1.1 vs 0.9±0.4; p<0.001). Conversely, Schirmer Test and OSDI score did not significantly differ between the two groups. DE was diagnosed in 14 out 46 hematological patients (30.4%). Meibomian gland loss was significantly higher in haematological patients compared to control subjects (29.8±15.0 vs 21.2±13.0; p=0.007). Patients with acute malignancies showed a lower meibomian gland loss compared to those with the other malignancies (24.3±12.1 vs 37.8±15.5; p=0.003). Meibography data were significantly correlated to meiboscore (R 2 =0.825; p=0.001), but not with other ocular and hematological parameters analyzed.

Conclusions : Morphological changes of meibomian glands cannot entirely be attributed to the pathogenetic mechanisms of ocular graft-versus-host disease, since hematological patients, particularly those affected by not acute malignancies, demonstrate significantly reduced meibomian gland areas already prior to HSCT.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.