Hematopoietic stem cell transplants may cause adverse effects on the meibomian glands (MG), a study in Cornea reports. And while meibomian gland dysfunction (MGD) is traditionally assessed by slit-lamp exams of the lid margins, infrared meibography may be a useful and more precise tool in detecting MG changes in these patients.
A team of researchers from Italy found MG function, loss and quality were all significantly worse after hematopoietic stem cell transplants. Additionally, patients who underwent myeloablative-conditioning regimens experienced greater MG loss.
Ocular graft-vs.-host disease (GVHD) is a major complication after hematopoietic stem cell transplants, occurring in 40% to 60% of patients, and MGD is frequent due to the functional impairment of MG that leads to tear film instability and dry eye disease, the researchers noted.
The investigation enrolled 33 patients and collected infrared meibography of the lower eyelid, Schirmer test, tear break-up time (TBUT), ocular surface staining and ocular surface disease index (OSDI) questionnaires prior to and four months after the stem cell transplant.
The study found MG loss and corneal staining greatly increased after the transplant (24.3±10.1% vs. 32.2±15.0% and 1.2±1.5 vs. 2.0±1.7 respectively). Conversely, TBUT showed a noticeable decrease from 6.6±4.2 seconds to 3.2±2.2 seconds.
They found no significant difference in the OSDI scores, despite higher results in the follow-up visits compared with baseline. The researchers thought this could be due to the study’s small sample size, relatively short follow-up period and the discomfort symptoms on the initial OSDI questionnaire.
At the four-month follow up, 19 patients (57.6%) were classified as ocular GVHD severity grade 0, eight (24.2%) were grade I and six patients (18.2%) were grade II. The percentage of MG loss prior to and after transplant didn’t differ between patients who developed ocular GVHD and those who did not, the researchers said.
Additionally, at four months, MG quality was worse in 16 patients (48.5%), remained unchanged in 14 (42.4%) and improved in three (9.1%).
Meibography is still a relatively new technique, and grading scales as well as user-friendly digital analysis software are still evolving to better evaluate the features of meibomian glands, the researchers noted. But meibography still represents a useful tool to detect MG changes in patients who undergo hematopoietic stem cell transplants and should be incorporated in the ophthalmological workup of these patients, they wrote in their paper.
|Bernabei F, Versura P, Pellegrini M, et al. Longitudinal analysis of infrared meibography in patients undergoing hematopoietic stem cell transplantation. Cornea. January 24, 2020. [Epub ahead of print].|