Purpose
To study the safety and effectiveness of autologous serum eye drop on dry eyes associated with graft-versus-host disease (GVHD).
Methods
A retrospective chart review of patients with history of GVHD was performed and pertinent clinical and demographic data was collected. Data collected included age, gender, date of bone marrow transplant, duration of GVHD, Schirmer’s test. Data also included subjective improvement of ocular surface irritation, change in visual acuity and severity of fluorescein corneal staining. Visual acuities were recorded using Snellen visual acuity. The corneal staining was graded on a subjective 0-4 scale. Grade 0 was considered no staining; grade 1 was mild staining; grade 2 was moderate staining; grade 3 was sever staining, and grade 4 was diffuse corneal staining.
Results
Fifteen patients were followed for a total of 285 patient months of observation. The average age of patients was 49± 10.3 years. The average time interval from the diagnosis of GVHD to the first ophthalmic exam was 30.6± 28.1 months. Seven patients (46.6%) reported improvement in their ocular symptoms after starting serum tears; three patients (20%) reported no change in their symptoms, and the remaining five patients made no comments regarding their symptoms. No patient reported worsening of symptoms. On average, the visual acuity improved by 0.085± 0.157 LogMAR after starting autologous serum tears. The Schirmer’s tests were on average 5.1± 5.3 mm. Nine eyes had improved fluorescein staining characteristics (52.9%), while the remaining eight eyes (47.1%) did not show any changes. On average the corneal staining scores improved by 1.64± 0.67. Diffuse staining in four eyes (36.4%) improved to severe staining in two eyes (18.2%), and moderate staining in another two eyes (18.2%); severe staining in five eyes (45.5%) improved to moderate staining in one eye (9%), mild staining in three eyes (27.3%), and no staining in one eye (9%); moderate staining in one eye (9%) improved to mild staining; and finally mild staining in one eye (9%) improved to no staining.
Conclusions
Autologous serum eye drops should be considered in patients with graft-versus-host disease who suffer from dry eyes. Future randomized clinical trials are needed to further investigate the effectiveness of autologous serum drops in treating and possibly preventing ocular complications of GVHD.
Keywords: 479 cornea: clinical science •
486 cornea: tears/tear film/dry eye