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Jay Ching-Chieh Wang, Heather O’Donnell, Joshua Teichman Teichman, Sonia Niki Yeung; Outcomes of patients with dry eye associated with graft versus host disease. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2021.
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Graft-versus-host disease (GVHD) is a multisystem complication of hematologic stem cell transplant (HSCT) occurring in 25%-70% of transplant recipients. Approximately 60-90% of these patients experience ocular GVHD (oGVHD), which most often manifests in the form of dry eye. To our knowledge, few studies have examined the risk factors associated with the development of severe oGVHD dry eyes.
The present study was approved by the University of British Columbia Research Ethics Board. A retrospective chart review of 79 HSCT patients referred by BC Cancer Agency (BCCA) for oGVHD was performed. Non-identifying descriptive and clinical data were collected, including ABO, CMV, EBV, HSV and HZV status of the HSCT recipient and donors, donor-to-recipient comparisons, donor relationship to recipient, transplant indications, transplant source, pre-transplant conditioning regimen, and systemic GVHD involvement according to National Institute of Health (NIH) GVHD grading. The characteristics of the population were analyzed. Linear, logistic, and ordered logistic regression analyses were performed where appropriate. The severity of patient’s dry eye was also stratified based on the NIH ocular involvement grading criteria.
The study population consisted of 79 patients, 47.4% of whom were male. Median age was 56 years (range 24 - 71), median Schirmer score was 0.1mm (range 0 - 25), and with a median time of 24 months (range 2 - 209) between transplant and examinations. Overall, male sex of the recipient was statistically significantly more predictive of worse dry eyes. Regression analysis revealed that male sex (p < 0.05) and decreasing Schirmer scores (p < 0.05) predicted worsening dry eye severity by NIH ocular involvement grading criteria. Moreover, global GVHD severity by NIH grading scale predicted severity of dry eye (p=0.002). Furthermore, 9 of 79 (11%) patients had severe disease requiring scleral contact lenses. The median age of this group was 46 years (range 30 - 60), consisted of 7 (78%) males and had a median Schirmer score of 0.0 mm (range 0 - 1.7). This group was statistically significantly younger (p < 0.05).
The outcome of this cohort identifies risk factors for severe disease so that these patients may be managed appropriately earlier on in the disease process. The results of this study will serve as a basis for future comparison to other cohorts with dry eyes from various causes.
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