Morphologic evaluation of meibomian glands in chronic graft-versus-host disease using in vivo laser confocal microscopy.
OBJECTIVE
To evaluate the morphological changes of the meibomian glands (MGs) using in vivo laser confocal microscopy (CM) in dry eye (DE) patients with chronic graft-versus-host disease (cGVHD).


METHODS
Seventeen eyes from 9 patients with a diagnosis of DE associated with cGVHD (DE/cGVHD group; 6 males, 3 females; median 50.5 years) and 16 eyes of 8 hematopoietic stem cell transplantation (HSCT) recipients without DE (non-DE/non-cGVHD group; 5 males, 3 females; median 47.0 years) were enrolled. CM was used to investigate the MG and MG acinar unit density (MGAUD), MG acinar longest diameter (MGALD), MG acinar shortest diameter (MGASD), and the fibrosis grade. Clinical findings of the lid margin were obtained. Tear dynamics, ocular surface vital staining, meibography, and MG expressibility were also examined. Data were compared between the 2 groups using the unpaired t and Mann-Whitney tests.


RESULTS
The mean MGAUD value was significantly lower in the DE/cGVHD group than in the non-DE/non-cGVHD group (p=0.01, 57.8±38.3 glands/mm(2), 88.8±26.6 glands/mm(2), respectively), and the mean MGALD and MGASD were significantly shorter in the DE/cGVHD group than in the non-DE/non-cGVHD group (p=0.0018, 37.3±24.4 μm and 60.4±11.8 μm, p=0.0106, 17.7±11.8 μm and 26.6±6.03 μm, respectively). The mean fibrosis grade was significantly higher in the DE/cGVHD group than the non-DE/non-cGVHD group (p<0.0001, 1.39±0.71 grade, 0.06±0.25 grade, respectively). Clinical findings in the lid margin, tear dynamics, and ocular surface findings were significantly worse in the DE/cGVHD group than in the non-DE/non-cGVHD group.


CONCLUSIONS
CM clearly depicted the morphological changes of the MG in the DE/cGVHD group, and revealed the severity of the meibomian gland dysfunction. Patients with severe DE after HSCT showed atrophic MG and excessive fibrosis.
Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan.
Yumiko
Y
Ban
Yoko
Y
Ogawa
Osama M A
OM
Ibrahim
Yukako
Y
Tatematsu
Mizuka
M
Kamoi
Miki
M
Uchino
Saori
S
Yaguchi
Murat
M
Dogru
Kazuo
K
Tsubota
D000328:Adult; D016022:Case-Control Studies; D002908:Chronic Disease; D015352:Dry Eye Syndromes / Q000209:etiology / Q000473:pathology*; D005260:Female; D005355:Fibrosis / Q000209:etiology / Q000473:pathology*; D006086:Graft vs Host Disease / Q000209:etiology / Q000473:pathology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007564:Japan; D007834:Lasers; D008297:Male; D008537:Meibomian Glands / Q000473:pathology* / Q000648:ultrastructure; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D013666:Tears / Q000502:physiology