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Surendra Basti, Radha Ram, Durga Borkar; Evaluation of conjunctival scarring in graft-versus-host disease. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5449.
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To evaluate the prevalence and presentation of conjunctival scarring in chronic graft-versus-host disease (GVHD) after hematopoietic stem cell transplantation (HSCT)
Retrospective analysis of prevalence, demographics, presentation, and systemic GVHD with respect to presence or absence of conjunctival scarring in patients with graft-versus-host disease and dry eye symptoms. For statistical analysis, odds ratio (OR), chi-squared test, and one-way ANOVA were used.
116 eyes of 58 patients (average age 47.4+/-12.97 years) were included. 43.1% had conjunctival scarring in the at least one eye and 39.7% had conjunctival scarring in both eyes. Median duration between transplant and presentation was 15 months. 56.9% had cutaneous GVHD, 27.6% had gastrointestinal GVHD, and 8.6% had pulmonary GVHD. Indications for HSCT included acute myeloid leukemia (34.5%), multiple myeloma (10.3%), lymphomas (12.1%), acute lymphoblastic leukemia (15.5%), and chronic myeloid leukemia (8.6%). Visual acuity did not differ between patients with conjunctival scarring and those without conjunctival scarring (p=0.378 OD, p=0.849 OS). Age (p=0.19) and gender (p=0.142) did not differ between groups. However, time between transplantation and presentation did differ (p=0.05): patients with conjunctival scarring presented a mean of 17.78 months after transplantation, whereas patients without scarring presented 34.29 months after transplantation. Gastrointestinal tract involvement, including oral mucositis, had a higher association with ocular GVHD (OR=1.800) when compared to cutaneous GVHD (OR=0.542) and pulmonary GVHD (OR=0.352). Schirmer’s values were lower in eyes with conjunctival scarring, but this difference was not statistically significant (p=0.174 OD, p=0.241 OS).
The prevalence of conjunctival scarring in patients with graft-versus-host disease in this study is significantly higher than previously reported. Because eyelid eversion can be performed readily at the slit lamp, this data emphasizes the importance of eyelid eversion in the assessment of ocular GVHD. Lastly, given the higher risk of ocular GVHD in patients with gastrointestinal GVHD, it is essential that ophthalmologists provide careful and regular exams on patients with gastrointestinal GVHD and approach the disease in a multidisciplinary fashion.
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