Conjunctival subepithelial fibrosis and meibomian gland atrophy in ocular graft-versus-host disease

Yael Kusne, M'hamed Temkit, Nandita Khera, Dharmendra R. Patel, Joanne F. Shen

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)784-788
Number of pages5
JournalOcular Surface
Issue number4
StatePublished - Oct 2017


  • Conjunctival scarring
  • Conjunctival subepithelial fibrosis
  • Dry eye
  • Meibomian gland
  • Ocular graft-versus-host disease

ASJC Scopus subject areas

  • Ophthalmology


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