Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Graft-Versus-Host Disease

Meibography and meibomian gland measurements in ocular graft-versus-host disease

Bone Marrow Transplantation volume 50, pages 961–967 (2015)Cite this article

Subjects

Abstract

Meibomian gland loss in ocular GvHD was described as a mechanism contributing to dry eye and severe damage to the ocular surface. Infrared images of upper eyelid meibomian glands from 86 ocular GvHD patients, from 10 patients after allogeneic stem cell transplantation (aSCT) without ocular GvHD, from 32 patients prior to aSCT and from 30 healthy controls were analyzed retrospectively and evaluated using two grading schemes. The upper meibomian gland area (uMGA) was calculated and set in relation to the total tarsal area of the lid. Results demonstrate that meibomian gland loss is significantly increased in patients with ocular GvHD as well as in patients prior to aSCT in comparison with controls (P between 0.05 and <0.001). Patients after aSCT without ocular GvHD had no significant difference in uMGA in comparison with controls. This study suggests that meibomian gland loss in GvHD patients is likely to be a multifactorial process that also occurs prior to aSCT, possibly due to underlying diseases and/or secondary to chemotherapy or irradiation. In addition, the question has to be addressed whether meibomian gland loss could serve as a predictor for the development of ocular GvHD. Overall, infrared meibography should be included in routine examination of patients undergoing aSCT and during follow-up.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

Similar content being viewed by others

References

  1. Dietrich-Ntoukas T, Cursiefen C, Westekemper H, Eberwein P, Reinhard T, Bertz H et al. Diagnosis and treatment of ocular chronic graft-versus-host disease: report from the German–Austrian–Swiss Consensus Conference on Clinical Practice in chronic GvHD. Cornea 2012; 31: 299–310.

    Article  Google Scholar 

  2. Shikari H, Antin JH, Dana R . Ocular graft-versus-host disease: a review. Surv Ophthalmol 2013; 58: 233–251.

    Article  Google Scholar 

  3. Espana EM, Shah S, Santhiago MR, Singh AD . Graft versus host disease: clinical evaluation, diagnosis and management. Graefe's Arch Clin Exp Ophthalmol 2013; 251: 1257–1266.

    Article  Google Scholar 

  4. Eberwein P, Issleib S, Bohringer D, Mittelviefhaus H, Schwartzkopff J, Finke J et al. Conjunctival HLA-DR and CD8 expression detected by impression cytology in ocular graft versus host disease. Mol Vis 2013; 19: 1492–1501.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Ban Y, Ogawa Y, Ibrahim OM, Tatematsu Y, Kamoi M, Uchino M et al. Morphologic evaluation of meibomian glands in chronic graft-versus-host disease using in vivo laser confocal microscopy. Mol Vis 2011; 17: 2533–2543.

    PubMed  PubMed Central  Google Scholar 

  6. Ibrahim OM, Matsumoto Y, Dogru M, Adan ES, Wakamatsu TH, Goto T et al. The efficacy, sensitivity, and specificity of in vivo laser confocal microscopy in the diagnosis of meibomian gland dysfunction. Ophthalmology 2010; 117: 665–672.

    Article  Google Scholar 

  7. Jacobs R, Tran U, Chen H, Kassim A, Engelhardt BG, Greer JP et al. Prevalence and risk factors associated with development of ocular GVHD defined by NIH consensus criteria. Bone Marrow Transplant 2012; 47: 1470–1473.

    Article  CAS  Google Scholar 

  8. Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant 2005; 11: 945–956.

    Article  Google Scholar 

  9. Pult H, Riede-Pult B . Comparison of subjective grading and objective assessment in meibography. Contact Lens Anterior Eye 2013; 36: 22–27.

    Article  Google Scholar 

  10. Arita R, Suehiro J, Haraguchi T, Shirakawa R, Tokoro H, Amano S . Objective image analysis of the meibomian gland area. Br J Ophthalmol 2013; 98: 746–755.

    Article  Google Scholar 

  11. Schiffman RM, Christianson MD, Jacobsen G, Hirsch JD, Reis BL . Reliability and validity of the ocular surface disease index. Arch Ophthalmol 2000; 118: 615–621.

    Article  CAS  Google Scholar 

  12. Stodtmeister R, Kessler KF, Schlorer J . [Tear film break-up time with different stains]. Klin Monbl Augenheilkd 1983; 183: 110–114.

    Article  CAS  Google Scholar 

  13. Bron AJ, Evans VE, Smith JA . Grading of corneal and conjunctival staining in the context of other dry eye tests. Cornea 2003; 22: 640–650.

    Article  Google Scholar 

  14. Ogawa Y, Okamoto S, Wakui M, Watanabe R, Yamada M, Yoshino M et al. Dry eye after haematopoietic stem cell transplantation. Br J Ophthalmol 1999; 83: 1125–1130.

    Article  CAS  Google Scholar 

  15. Bray LC, Carey PJ, Proctor SJ, Evans RG, Hamilton PJ . Ocular complications of bone marrow transplantation. Br J Ophthalmol 1991; 75: 611–614.

    Article  CAS  Google Scholar 

  16. Ferrara JL, Deeg HJ . Graft-versus-host disease. N Eng J Med 1991; 324: 667–674.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This study was supported by the Helmut und Ruth Lingen Stiftung, Cologne, Germany, by Oculus GmbH, Wetzlar, Germany, through loan of equipment and by Deutsche Forschungsgemeinschaft (DFG FOR 2240/STE 1928/4-1).

Author information

Authors and Affiliations

  1. Department of Ophthalmology, University of Cologne, Cologne, Germany

    L A Engel, S Wittig, F Bock, L Sauerbier, C Cursiefen & P Steven

  2. Ocular GvHD Competence Center, University of Cologne, Cologne, Germany

    L A Engel, S Wittig, C Scheid, M Hallek, C Cursiefen & P Steven

  3. Department of Ophthalmology, CORIC (Cologne Ophthalmological Reading and Image Analysis Center), University of Cologne, Cologne, Germany

    F Bock & C Cursiefen

  4. Excellence Cluster: Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany

    L Sauerbier, M Hallek & P Steven

  5. Department I of Internal Medicine, University of Cologne, Cologne, Germany

    C Scheid, U Holtick, J-M Chemnitz & M Hallek

Authors
  1. L A Engel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S Wittig
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F Bock
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L Sauerbier
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C Scheid
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. U Holtick
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J-M Chemnitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M Hallek
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. C Cursiefen
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. P Steven
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P Steven.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Engel, L., Wittig, S., Bock, F. et al. Meibography and meibomian gland measurements in ocular graft-versus-host disease. Bone Marrow Transplant 50, 961–967 (2015). https://doi.org/10.1038/bmt.2015.72

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2015.72

This article is cited by

Search

Advanced search

Quick links