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S.K. Kim, D. Couriel, D. Gombos, B. Esmaeli; Early Topical Steroid Treatment for Grade IV Acute Ocular Graft vs. Host Disease (GVHD) with Corneal Epithelial Sloughing . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1387.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To describe the benefit of early application of topical steroid for the treatment of grade IV acute ocular graft vs. host disease (GVHD), a rare but devastating complication of allogeneic blood and marrow transplantation. Methods: Three cases of grade IV acute ocular GVHD from MD Anderson Cancer Center were retrospectively compared. Two patients with acute ocular GVHD grade IV with corneal involvement (>70% defect) were treated with topical steroid initially plus lubrication vs. one patient with early lubrication alone followed by topical steroids. Four other cases of grade IV acute ocular GVHD from MDACC were also reviewed for the treatment modality and response pattern. Comprehensive literature review on treatment of ocular graft vs. host disease was performed. Results: All patients were maximally immunosuppressed systemically. For the two patients with early topical steroid treatment, the corneal epithelial defect healed in 3-5 days, without scarring, with 20/20-20/25 vision vs. the patient with early lubrication followed by topical steroid experienced delayed healing (4 weeks), corneal scarring, and 20/30-20/40 vision. No standard treatment for acute ocular GVHD with corneal epithelial sloughing has been described in the literature. Conclusions: While a larger series is needed to fully understand of effects of topical steroid for the treatment of corneal epithelial disease in ocular GVHD, these cases may suggest the possible benefit of early topical steroid to treat grade IV acute ocular GVHD.
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