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Yuna Rapoport, Adetola Kassim, Thomas Freeman, Tatsuki Koyama, Uyen Tran; Validating the International Chronic Ocular Graft-vs-Host-Disease (GVHD) Consensus Group: Proposed Diagnostic Criteria for Chronic GVHD. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5663.
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To determine the correlation between the clinical score of ocular GVHD by one ophthalmologist versus the Proposed Diagnostic Criteria proposed by the International Chronic Ocular GVHD Consensus Group. The secondary purpose is to determine whether ocular GVHD patients who received a Boston Scleral Lens had a better score at the last visit recorded than those who did not.
Retrospective chart review was performed on 347 patients who received a stem cell transplant at Vanderbilt University Medical Center in Nashville, Tennessee from January 1, 2002 through April 17, 2014. In patients affected by ocular GVHD, data collected included Schirmer’s test, corneal fluorescein staining, Ocular Surface Disease Index, conjunctival injection, and treatment with a Boston Scleral lens. The overall severity score (points) based on the Criteria was then calculated.
A total of 347 patients were reviewed. One hundred and forty one developed ocular GVHD and 86 had complete charts. Of these, the clinical assessment stage of ocular GVHD patients was found to have a slight to fair agreement (Kappa statistic 0.195, with 95% confidence interval 0.036, 0.355) with the Proposed Diagnostic Criteria by the International Chronic Ocular GVHD Consensus Group. Thirteen patients received a Boston scleral lens and those patients had a significantly better stage upon the last clinic visit than those who received conventional medical therapy (Wilcoxon rank sum test p-value 0.007).
Our data shows that the clinical assessment of ocular GVHD patients has only a slight to fair correlation with Criteria. The largest discrepancy was found in the group that had mild disease by our clinical assessment versus none by the Criteria. Factors that may play into this include: the inconsistency of Schirmers scores and the fact that corneal fluorescein staining may be absent in the mild stages of dry eyes. Patients who received a Boston scleral lens had better improvement than those who received traditional medical therapy, suggesting that this treatment should be considered earlier in the disease course in ocular GVHD patients. Prospective studies are needed to further validate the severity stages of ocular GVHD as proposed by the International Chronic Ocular GVHD Consensus Group.<br />
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