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Sankaranarayana Mahesh, Christopher Rapuano, Parveen Nagra, Kristin Hammersmith; Ocular manifestations and treatment outcomes of patients with graft-versus-host disease. Invest. Ophthalmol. Vis. Sci. 2013;54(15):6032.
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Graft versus host disease (GVHD) is a major cause of morbidity and mortality in patients undergoing hematopoietic stem cell transplantation. The purpose of this study was to evaluate the clinical manifestations and treatment outcomes in patients with graft versus host disease.
Patients followed in the eye clinic with ocular graft versus host disease were included in the study. A retrospective chart review of patients with ocular GVHD including demographic features, baseline clinical features, treatment and survival data was performed. GVHD was classified based on NIH criteria while dry eye disease was classified based on the Dry eye workshop criteria.
38 patients with ocular GVHD were included. The mean age was 50.3 yrs with a mean follow up 22.9 months. The commonest indication for allogenic hematopoietic stem cell transplantation was acute myelogenic leukemia (29%). 25 patients received conventional bone marrow transplantation while 13 patients had allogenic peripheral blood stem cell transplantation. 34 patients had chronic GVHD while 2 patients had overlap syndrome. The mean time to systemic GVHD (9.6 months) differed from time to ocular GVHD (34.7 months). The commonest systemic features included involvement of skin (97%), mouth (47%) and liver (52%). Severe DES was seen in 27 (71%) patients. Commonest clinical features included Punctate keratitis (94.7%), conjunctival scarring (37%), filamentary keratitis (18.4%) and LSCD (13.2%). 7 patients had corneal ulcers resulting in corneal perforation in 4 patients (13%). Lubrication (100%), Restasis (65.8%) and Punctal plugs (65.8%) formed the mainstay of treatment. PROSE lens was fitted in 5 patients while it was recommended in additional 8 patients. 4 patients underwent amniotic membrane transplantation while 2 patients underwent corneal transplantation. DES improved (n=23, 61%), remained same in 6 patients (16%) while worsened in 8 patients (21%).
Ocular surface disease is a severe vision threatening complication that should be recognized in patients with GVHD and can be improved with appropriate treatment.
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