@article {1304383, title = {Subtarsal Fibrosis Is Associated With Ocular Surface Epitheliopathy in Graft-Versus-Host Disease}, journal = {Am J Ophthalmol}, volume = {189}, year = {2018}, month = {2018 May}, pages = {102-110}, abstract = {PURPOSE: To evaluate occurrence of subtarsal fibrosis in patients with graft-vs-host disease (GVHD) and to determine its association with ocular surface epitheliopathy. DESIGN: Cross-sectional study. METHODS: We enrolled 40 patients with moderate or severe dry eye disease, including 20 patients with chronic ocular GVHD and 20 patients without (as the control group). All patients had a comprehensive ophthalmic assessment including evaluation for subtarsal fibrosis, corneal and conjunctival staining, tear break-up time (TBUT), and Schirmer test. Furthermore, meibomian gland drop-out area and densities of epithelial and stromal immune cells were measured using meibography and in~vivo confocal microscopy, respectively. RESULTS: Subtarsal fibrosis was not seen in any eye of the non-GVHD group. However, 16 eyes (40\%) of 10 patients (50\%) in the GVHD group had subtarsal fibrosis (P < .001) with an average involvement of 28.9\% {\textpm} 13.7\% of the tarsal area. Fibrosis was more frequent in the upper lids (35\%) than in the lower lids (5\%). Regression analyses showed that corneal fluorescein staining was significantly associated with the extent of fibrosis (P < .001, β~= 0.14) and TBUT (P < .001, β~=~-0.53) but not with other clinical or imaging parameters. Conjunctival lissamine green staining also had a statistically significant association with the extent of fibrosis (P~= .04, β~= 0.12) but not other clinical or imaging parameters. Eyes with subtarsal fibrosis had a more severe ocular surface epitheliopathy compared with eyes without fibrosis. CONCLUSIONS: Subtarsal fibrosis is present in a significant percentage of patients with chronic ocular GVHD, likely contributing to the ocular surface damage in these patients.}, issn = {1879-1891}, doi = {10.1016/j.ajo.2018.02.020}, author = {Kheirkhah, Ahmad and Coco, Giulia and Satitpitakul, Vannarut and Dana, Reza} }