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Hasanain Shikari, Ujwala Saboo, Reza Dana; Ocular Surface Disease Characteristics in Patients with Ocular Graft-versus-Host Disease (GVHD).. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4331.
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The ocular surface can be a target of chronic ocular GVHD. 40-60% of the patients develop or experience worsening of dry eye disease after bone marrow transplantation. The purpose of this study was to describe the range and extent of ocular surface disease in patients with ocular GVHD.
A retrospective review of 91 patients presenting to the Cornea Clinic within 2 months of experiencing ocular surface symptoms was conducted. Symptom assessment included the Ocular Surface Disease Index (OSDI®) and Symptom Assessment iN Dry Eye (SANDE) questionnaires. Ocular surface disease signs included the Schirmer test, tear osmolarity, modified Oxford corneal flourescein staining (CFS), and tear break-up time (TBUT).
45 males and 46 females with a mean age of 51±12 years (±SD) were included. Ocular signs and symptoms suggestive of GVHD developed at 455±71 days (mean±SEM) after bone marrow transplantation. Mean±SEM for other variables included: OSDI questionnaire score of 51±5.3; SANDE frequency of 64.7±5.6; SANDE severity of 59.5±6; Schirmer score of 6.0±0.4 mm at 5 minutes; tear film osmolarity of 306±4 mOsm; CFS 2±0.1; and TBUT of 3±0.2 seconds. Overall, there was a negative correlation (Spearman’s R= -0.4, p<0.0001) between Schirmer and CFS score. However, 17 eyes presented with mean Schirmer score >10mm (mean 15.7±0.9mm) and corresponding CFS of 1.8±0.3; and 19 eyes with Schirmer between 6-10 (mean 7.8±0.3mm) and CFS 1.1±0.2.
Ocular GVHD typically presents >1 year after bone marrow transplantation. These patients tend to have severe symptoms coincident with extensive corneal epitheliopathy. However, Schirmer scores may vary significantly, and do not always correlate with other disease parameters, and thus should not be the principal diagnostic or prognostic parameter in assessing these patients.
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