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N. Ghaznawi, K. Hammersmith; Spectrum of Ocular Disease in Graft Versus Host Disease After Allogenic Hematopoetic Stem Cell Transplantation. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3767.
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To study the incidence, causes, and outcomes of ocular complications of patients with graft-versus-host disease (GVHD)
This was a retrospective, noncomparative observational case series of 22 patients with GVHD after allogenic hematopoetic stem cell transplantation (HSCT) for hematologic and lymphoid malignancies referred to a tertiary care center for evaluation of ocular complaints from 2006 to 2009. Patients underwent full ophthalmologic assessment including visual acuity, tonometry, Schirmer test, biomicroscopy and dilated ophthalmoscopy. The incidence of ocular complications, treatments, and clinical courses were studied and photography performed when pertinent. Mean time of follow up is 8.8 months.
Of the 22 patients identified there were 14(63%) male and 8(37%) female patients with a mean age of 52 (25 to 70 years.) 15 patients(68%) had history of allogenic bone marrow transplantation, 5 patients(23%) underwent HSCT from peripheral blood, and 2(1%) were not reported. GVHD was managed with cyclophosphamide, mycophenalate mofetil, prednisone, or cytoxan in 77% of patients. The most common complication was dry eyes(DES)(91%), DES with filamentary keratitis(18%), rosacea blepharitis (32%),symblepharon (14%), cataract progression(14%), bacterial keratitis(14%),limbal stem cell deficiency(9%) ,conjunctival CIN (4%), descemetocoele (4%),superior limbic keratitis(4%),graft rejection (4%), bacterial canaliculitis (4%), steroid response glaucoma (4%), and conjunctivalization of the cornea (4%). 14 % of DES patients were managed with tear replacement alone, where as 86% of patients required additional therapy including Restasis (55%), punctual plugs (50%), topical steroids (32%), punctal cautery (27%), autologous serum (18%), Boston scleral lens (14%), and tarsorraphy (4%). 23% of patients with DES required doxycycline for rosacea blepharitis. One patient underwent limbal stem cell transplantation and several subsequent PKs 1 patient underwent repeat lamellar keratectomy with amniotic membrane transplantation , 1 patient underwent and phacoemulsification, and 1 patient underwent conjuntival tumor resection and cryotherapy
Since recent advancements in the treatment of patients with hematologic malignancies with stem cell transplantation, the incidence of GVHD has increased. Graft versus host disease is an important cause of ocular complications. As these patients represent a unique clinical challenge, the ophthalmologist must be aware of the spectrum of ophthalmic disease in GVHD, and the incidence of severe sight threatening complications
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