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Narae Ko, Yichen Sun, Yoshihiro Inamoto, Stephanie Lee, Tueng Shen; Extended Soft Bandage Contact Lenses Therapy for Ocular Graft-Versus-Host Disease. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3064.
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Ocular Graft-versus-Host Disease (GVHD) affects 40-60% of patients with allogeneic hematopoietic stem cell transplantation. The most common symptoms, including photophobia, eye pain, and blurring of vision, can have a large impact on daily living. We applied extended soft bandage contact lens (BCL) on symptomatic ocular GHVD patients and assessed its clinical outcome.
A prospective, phase II study was performed with Institutional Review Board approval. Patients older than 18 years old with diagnosis of GHVD defined by the NIH criteria and ocular symptoms with NIH eye score of 2 or greater were recruited. Extended soft bandage contact lenses were placed with antibiotic coverage for at least 1 month. Visual acuity and slit lamp microscopy exam were performed on initial presentation, at 2 and 4 weeks of treatment. Statistical analysis of visual acuity was done using one-tailed Z-test.
Thirty-eight eyes of 19 patients with ocular GVHD underwent contact lens placement. The mean Snellen acuity before treatment was 20/31(LogMar 0.18). Visual acuity at 2 weeks of contact lens wear was 20/27 (LogMar 0.13, p<0.001) and 20/30 at 4 weeks (LogMar 0.17, p>0.05). Twenty-four out of 25 eyes (96%) which initially presented with conjunctival inflammation (chemosis, injection, or staining) showed improvement after 2 and 4 weeks of BCL wear. Twenty-three of 30 eyes (76.7%) with punctate epithelial defect and 8 out of 15 (53.3%) eyes with filamentous keratopathy showed improvement after 2 and 4 weeks of BCL wear.
Visual acuity improved in patients with ocular GVHD after 2 weeks of soft BCL wear but the improvement was no longer seen at 4 weeks. Conjunctival inflammation, punctate epithelial defect and filmanetous keratopathy all improved after BCL wear. These results support the use of BCL in patients with ocular GHVD.
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