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Yichen Sun, Yoshihiro Inamoto, Joseph Sheehan, Peng Li, Ruikang Wang, Stephanie Lee, Tueng Shen; Extended Soft Bandage Contact Lenses Therapy for Ocular Graft-Versus-Host Disease. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5440.
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Graft-versus-Host Disease (GVHD) is a major complication of allogenic tissue/hematopoietic stem cell transplantation. 60% of GVHD patients have ocular involvement with significant compromise in quality of life due to ocular symptoms (such as severe photophobia, pain and decreased visual acuity). We report the outcome of extended soft bandage contact lens (BCL) treatment for symptomatic relief and ocular surface protection in GVHD patients.
Prospective Phase II clinical trial. IRB approval of the clinical protocol was first obtained. Patients (age 18-99) with diagnosis of chronic GVHD as defined by the NIH criteria and ocular symptoms of NIH eye score 2 or greater are selected for the study with written informed consent. Extended soft bandage contact lenses were applied to the GVHD-affected eyes with antibiotic coverage during the two week period. Ocular exam, anterior segment OCT (AS-OCT) and patient survey are obtained. Patients are followed for one month. Clinical outcomes, such as visual acuity, corneal presentations (abrasion, punctate epithelial erosion and filament) are correlated with symptomatic survey findings as well as OCT findings.
20 patients with ocular GVHD will be included in the study. Ocular manifestations of GVHD observed by clinical exam are also characterized by AS-OCT. First six including patients are all shown with improving symptoms/signs and without any occurrence of complications. Symptomatic changes with the BCL therapy are correlated with ocular exams as well as AS-OCT.
BCL can offer significant symptomatic relief for patients with ocular GVHD. AS-OCT can be a feasible method to characterize pathological changes related to ocular GVHD. In addition, wearing of extended soft bandage contact lens can diminish the attrition of cornea from eyelid and provide symptomatic relief for patients with ocular GVHD.
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