Abstract
BackgroundRadiation therapy (RT) is the treatment of choice in patients with low-grade ocular adenexal mucosa-associated lymphoid tissue lymphoma (OAML) and many of them experience post-RT dry eye with varying severity. The purpose of the present study was to investigate ocular effects of RT on meibomian glands and dry eye by directly visualizing structural changes. Secondly, we focused on the comparison of two groups of patients according to tumor location and radiation technique.MethodsSixty-four eyes with OAML of conjunctiva, orbit, lacrimal gland, or lacrimal sac were grouped into conjunctival lymphoma and “orbital-type” lymphoma (i.e., orbit, lacrimal gland, and lacrimal sac). Subjects were investigated for morphological changes in meibomian glands by meiboscore grading system. Radiation technique was examined and Ocular Surface Disease Index (OSDI) questionnaire, Schirmer’s test, tear film break-up time (TBUT), slit lamp examination of corneal surface and lid margin abnormality were conducted before and after RT.ResultsThe increase in meiboscore was statistically significant over time after RT in both groups (P < 0.001). The extent of increase in meiboscore was significantly greater in the “orbital-type” lymphoma group than in the conjunctival lymphoma group (P < 0.001). The changes in OSDI, TBUT, corneal fluorescein staining score and lid margin abnormality score after RT were significantly different across two groups (P = 0.042, 0.001, 0.035 and 0.001, respectively). Schirmer’s value decreased after RT in both groups. Dry eye symptoms were most severe right after RT in both groups, but a gradual resolution was noted in most patients with conjunctival lymphoma, whereas symptoms persisted in “orbital-type” lymphoma patients. The OSDI score and corneal fluorescein staining score were positively correlated with meiboscore in “orbital-type” patients at post-RT 6 months (r = 0.43, P = 0.04; r = 0.39, P = 0.03, respectively).ConclusionsPatients with OAML had different degrees of morphological changes in meibomian glands according to tumor location and radiation technique. “Orbital-type” lymphoma patients are more likely to experience severe injury to meibomian glands, which eventually leads to persistent dry eye. Patients with “orbital-type” lymphoma should be well informed of post-RT damage on meibomian glands and persistent dry eye.
Highlights
Radiation therapy (RT) is the treatment of choice in patients with low-grade ocular adenexal mucosaassociated lymphoid tissue lymphoma (OAML) and many of them experience post-RT dry eye with varying severity
Meibomian gland dysfunction (MGD) is one of the most common causes of dry eye syndrome [14, 15] and, to our knowledge, there has been no study aimed at directly visualizing structural changes in the meibomian glands sequentially over time beginning with the initiation of RT
This study investigated the adverse effects of the external beam radiation therapy (EBRT) on the meibomian glands in patients with OAML
Summary
Radiation therapy (RT) is the treatment of choice in patients with low-grade ocular adenexal mucosaassociated lymphoid tissue lymphoma (OAML) and many of them experience post-RT dry eye with varying severity. Radiation therapy is the treatment of choice for low-grade primary ocular adnexal MALT lymphoma (OAML) as it is very effective in terms of local control and generally well-tolerated [2,3,4,5]. Meibomian gland dysfunction (MGD) is one of the most common causes of dry eye syndrome [14, 15] and, to our knowledge, there has been no study aimed at directly visualizing structural changes in the meibomian glands sequentially over time beginning with the initiation of RT. We focused on the comparison of two groups of patients (those with conjunctival lymphoma and those with “orbital-type” lymphoma) because the radiation technique used was different depending on the location of the tumor [16,17,18]
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