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眼移植物抗宿主疾病的结膜上皮纤维化和睑板腺萎缩

Kusne, Y., Temkit, M., Khera, N., Patel, D.R., Shen, J.F.

期刊名称:The Ocular Surface

卷期:2017年第15卷第4期

摘要

摘要:目的:干眼症状极大影响了眼部移植物抗宿主病(oGVHD)患者的生活质量。 已报道oGVHD存在各种眼表变化,包括睑板腺萎缩(MGA)和临床结膜瘢痕或上皮下纤维化(CSEF)。我们检查了oGVHDCSEFMGA和其他眼表变化之间的关系。方法:对单个眼科医生检查的21例连续GVHD患者进行回顾性分析。使用先前发表的方法,计算每例患者的国际慢性眼部移植物抗宿主病共识组(ICCG)评分。对裂隙灯检查的CSEF严重程度以及红外线摄影显示的MGA严重程度进行了评估。使用ImageJ分析红外光学图像以确定MGA百分比。使用SAS Studio 9.3SAS InstituteCaryNC)计算Pearson相关系数。结果:在42只眼中,检测的变量(CSEF评分,ICCG评分,MGA)没有明显相关性。 21例患者中有20例进一步检查发现眼不对称。分析更严重眼(n = 21)显示ICCG评分与CSEF之间呈弱阳性相关(r = 0.54; p = 0.01)。没有发现其他统计学显着相关性。结论:临床CSEF可能是GVHD对眼表面影响的重要标志,可能与oGVHD严重程度评估有关。虽然睑板腺和结膜紧密相连,但MGA与临床CSEF发现无关。一些眼部GVHD患者可能会出现不对称眼部发现,尽管GHVD具有系统性,但一只眼显示更严重的病理变化和症状。需要进一步的研究来检查这些发现。

PURPOSE:Dry eye symptoms greatly impact patients' quality of life in ocular graft-versus-host disease (oGVHD). Various ocular surface changes have been reported in oGVHD, including meibomian gland atrophy (MGA) and clinical conjunctival scarring or subepithelial fibrosis (CSEF). The relationships between CSEF, MGA, and other ocular surface changes in oGVHD were examined.METHODS:Charts of 21 consecutive GVHD patients examined by a single ophthalmologist were retrospectively reviewed. International Chronic Ocular Graft-vs-Host-Disease Consensus Group (ICCG) scores were calculated for each patient using previously published methods. The severity of CSEF by slit lamp examination and MGA by infrared meibography were also assessed for each patient. Infrared meibography images were analyzed using ImageJ to determine percent of MGA. Pearson correlation coefficients were calculated using SAS Studio 9.3 (SAS Institute, Cary, NC).RESULTS:In the 42 eyes, no significant correlations were identified among the variables examined (CSEF score, ICCG score, MGA). Further examination revealed asymmetric ocular findings in 20 of 21 patients. Analysis of the more severe eye alone (n = 21) revealed a weakly positive correlation between ICCG score and CSEF (r = 0.54; p = 0.01). No other statistically significant correlations were found.CONCLUSIONS:Clinical CSEF may be an important sign of GVHD impact on the ocular surface and may be relevant in oGVHD severity assessment. Though meibomian glands and conjunctiva are in close proximity, MGA did not correlate with clinical CSEF findings. Some ocular GVHD patients may present with asymmetrical ocular findings, with one eye displaying more severe pathological changes and symptoms despite the systemic nature of GHVD. Further studies are needed to examine these findings.


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