Purchase this article with an account.
Zaina Al-Mohtaseb, Tayyeba Ali, Daniel Waren, Samantha Herretes, Juan Carlos Murillo, Carolina Betancurt, Victor L Perez; Evaluation of the Ocular Surface in Patients with Graft-versus-Host Disease at the Bascom Palmer Eye Institute. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2019.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Despite improvements in human leukocyte antigen matching and pharmacologic prophylaxis, graft-versus-host disease (GVHD) continues to present with significant morbidity and mortality following hematopoietic stem cell transplants (HSCT). Ocular GVHD (oGVHD) can affect the cornea, conjunctiva, eyelids, lacrimal gland, as well as the posterior segment, leading to severe vision loss in both the acute and chronic phases of the disease. We hypothesize that the combination of both aqueous tear deficiency and evaporative dry eye results in the damage to the ocular surface seen in patients with oGVHD.
We performed a complete evaluation of the ocular surface in consecutive patients that presented to the Bascom Palmer Ocular Surface Center following an HSCT. Patients with oGVHD were compared to patients with GVHD but without ocular manifestations of the disease. Patient symptoms were evaluated using the ocular surface disease index (OSDI), Lee Dry Eye and NIH eye scores. Evaluation of the ocular surface, tear function, and meibomian glands was performed using direct slit lamp evaluation, Schirmer testing, fluorescein and lissamine green staining, tear break up time (TBUT), osmolarity, and interferometry.
Patients with oGVHD showed both subjective and objective evidence of dry eyes when compared to GVHD patients without ocular manifestations. oGVHD patients exhibited both higher OSDI, Lee Dry Eye and NIH eye scores and greater fluorescein corneal staining and lissamine green conjunctival staining, all of which were statistically significant (p-value <0.05). Patients with oGVHD also showed evidence of aqueous tear deficiency with lower Schirmer scores. In addition, when compared to patients without oGVHD, they had a higher incidence of evaporative dry eye, as shown by decreased TBUT and increased MGD lid-composite scores.
In summary, this systematic approach using multiple subjective and objective tests has helped us characterize, define and evaluate the ocular surface of patients with oGVHD. This study shows that the evaluation of aqueous tear deficiency and meibomian glands and treatment of their dysfunction is critical to preserve and maintain the ocular surface in these patients.
This PDF is available to Subscribers Only