BACKGROUND Radiation 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. METHODS Sixty-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. RESULTS The 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). CONCLUSIONS Patients 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.

中文翻译：

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放射治疗对眼附件黏膜相关淋巴样淋巴瘤患者睑板腺和干眼的影响。

背景技术放射治疗（RT）是低度眼部腺附件黏膜相关淋巴样组织淋巴瘤（OAML）患者的首选治疗方法，其中许多患者经历了严重程度不同的RT后干眼症。本研究的目的是通过直接观察结构变化来研究RT对睑板腺和干眼的眼效应。其次，我们根据肿瘤的位置和放射线技术对两组患者进行比较。方法将64眼结膜，眼眶，泪腺或泪囊OAML眼分为结膜淋巴瘤和“眼眶型”淋巴瘤（即眼眶，泪腺和泪囊）。通过meiboscore评分系统调查受试者的睑板腺形态变化。在放疗前后，对放射技术进行了检查，并进行了眼表疾病指数（OSDI）问卷，Schirmer检验，泪膜破裂时间（TBUT），裂隙灯检查角膜表面和眼睑边缘异常。结果两组在放疗后，meiboscore的增加随时间推移具有统计学意义（P <0.001）。与眼结膜淋巴瘤组相比，“眼眶型”淋巴瘤组中meiboscore的增加幅度明显更大（P <0.001）。RT后OSDI，TBUT，角膜荧光素染色评分和眼睑边缘异常评分的变化在两组之间有显着差异（分别为P = 0.042、0.001、0.035和0.001）。两组RT后Schirmer值均降低。两组在接受RT治疗后，干眼症状最为严重，但是在大多数结膜淋巴瘤患者中注意到逐渐消失，而“眼眶型”淋巴瘤患者的症状仍然存在。RT后6个月，“眼眶型”患者的OSDI评分和角膜荧光素染色评分与meiboscore呈正相关（r = 0.43，P = 0.04； r = 0.39，P = 0.03）。结论根据肿瘤部位和放射技术，OAML患者睑板腺的形态变化程度不同。“眼眶型”淋巴瘤患者更容易遭受睑板腺的严重损伤，最终导致持续的干眼症。患有“眼眶型”淋巴瘤的患者应充分了解RT后对睑板腺和持续性干眼的损害。