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Morphologic evaluation of meibomian glands in chronic graft-versus-host disease using in vivo laser confocal microscopy.

Ban Y, Ogawa Y, Ibrahim OM, Tatematsu Y, Kamoi M, Uchino M, Yaguchi S, Dogru M, Tsubota K - Mol. Vis. (2011)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan.

ABSTRACT

Purpose: 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.

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Related in: MedlinePlus

Meibomian gland of DE/cGVHD patient images observed by in vivo laser confocal microscopy. DE/cGVHD group, 55-year-old male (Case 9; Table 1). The images observed after 17 months on the onset of DE related to cGVHD. Note the excessive fibrosis around the atrophic glands and the mild infiltration of inflammatory cells in the dry eye patients with cGVHD. LL=Lower, Left.
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f4: Meibomian gland of DE/cGVHD patient images observed by in vivo laser confocal microscopy. DE/cGVHD group, 55-year-old male (Case 9; Table 1). The images observed after 17 months on the onset of DE related to cGVHD. Note the excessive fibrosis around the atrophic glands and the mild infiltration of inflammatory cells in the dry eye patients with cGVHD. LL=Lower, Left.

Mentions: CM clearly depicted the glandular acinar units in the non-DE/non-cGVHD group. The CM images also revealed morphologic alterations in the DE/cGVHD group, including atrophic MG and extensive fibrosis. The confocal microscopic images observed at the onset of DE related to cGVHD from a representative 47-year-old male (Case 2; Table 1) in the DE/cGVHD group showed the excessive fibrosis around the atrophic glands and the moderate infiltration of inflammatory cells (Figure 3B,D). Seventeen months after the onset of DE related to cGVHD showed the excessive fibrosis around the atrophic glands and the mild infiltration of inflammatory cells from a representative 55-year-old male patient (Case 9; Table 1) in the DE/cGVHD group (Figure 4). In contrast, the confocal microscopic images from a representative 61-year-old female (Case 6; Table 2) in non-DE/non-cGVHD group showed the presence of numerous and compact acinar units (Figure 5).


Morphologic evaluation of meibomian glands in chronic graft-versus-host disease using in vivo laser confocal microscopy.

Ban Y, Ogawa Y, Ibrahim OM, Tatematsu Y, Kamoi M, Uchino M, Yaguchi S, Dogru M, Tsubota K - Mol. Vis. (2011)

Meibomian gland of DE/cGVHD patient images observed by in vivo laser confocal microscopy. DE/cGVHD group, 55-year-old male (Case 9; Table 1). The images observed after 17 months on the onset of DE related to cGVHD. Note the excessive fibrosis around the atrophic glands and the mild infiltration of inflammatory cells in the dry eye patients with cGVHD. LL=Lower, Left.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3198483&req=5

f4: Meibomian gland of DE/cGVHD patient images observed by in vivo laser confocal microscopy. DE/cGVHD group, 55-year-old male (Case 9; Table 1). The images observed after 17 months on the onset of DE related to cGVHD. Note the excessive fibrosis around the atrophic glands and the mild infiltration of inflammatory cells in the dry eye patients with cGVHD. LL=Lower, Left.
Mentions: CM clearly depicted the glandular acinar units in the non-DE/non-cGVHD group. The CM images also revealed morphologic alterations in the DE/cGVHD group, including atrophic MG and extensive fibrosis. The confocal microscopic images observed at the onset of DE related to cGVHD from a representative 47-year-old male (Case 2; Table 1) in the DE/cGVHD group showed the excessive fibrosis around the atrophic glands and the moderate infiltration of inflammatory cells (Figure 3B,D). Seventeen months after the onset of DE related to cGVHD showed the excessive fibrosis around the atrophic glands and the mild infiltration of inflammatory cells from a representative 55-year-old male patient (Case 9; Table 1) in the DE/cGVHD group (Figure 4). In contrast, the confocal microscopic images from a representative 61-year-old female (Case 6; Table 2) in non-DE/non-cGVHD group showed the presence of numerous and compact acinar units (Figure 5).

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan.

ABSTRACT

Purpose: 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.

Show MeSH
Related in: MedlinePlus