April 2014
Volume 55, Issue 13
ARVO Annual Meeting Abstract  |   April 2014
Evaluation of the Ocular Surface in Patients with Graft-versus-Host Disease at the Bascom Palmer Eye Institute
Author Affiliations & Notes
  • Zaina Al-Mohtaseb
    Bascom Palmer Eye Institute, Miami, FL
  • Tayyeba Ali
    Bascom Palmer Eye Institute, Miami, FL
  • Daniel Waren
    Bascom Palmer Eye Institute, Miami, FL
  • Samantha Herretes
    Bascom Palmer Eye Institute, Miami, FL
  • Juan Carlos Murillo
    Bascom Palmer Eye Institute, Miami, FL
  • Carolina Betancurt
    Bascom Palmer Eye Institute, Miami, FL
  • Victor L Perez
    Bascom Palmer Eye Institute, Miami, FL
  • Footnotes
    Commercial Relationships Zaina Al-Mohtaseb, None; Tayyeba Ali, None; Daniel Waren, None; Samantha Herretes, None; Juan Murillo, None; Carolina Betancurt, None; Victor Perez, Allergan (C)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 2019. doi:
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      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.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: 486 cornea: tears/tear film/dry eye  

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