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E. Allan, M. Wu, P. Martin, M. Flowers, R. Bensinger; Ocular Findings in Patients With Chronic Graft-Versus-Host Disease. Invest. Ophthalmol. Vis. Sci. 2008;49(13):433.
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Chronic graft-versus-host disease (cGVHD) is a common complication of allogeneic bone marrow transplantation (BMT) with ocular morbidity becoming a greater concern. The goal of this study is to determine prevalence of ocular findings and evaluate visual acuity in patients with cGVHD following an allogeneic BMT.
A retrospective review was performed on an electronic database containing all patients receiving an allogeneic bone marrow transplantation at Fred Hutchinson Cancer Research Center between 1990 and 2006. Consecutive review was completed on ophthalmic notes of 704 patients, who were referred to an ophthalmologist per protocol because of a Schirmer's score of <15mm (1990-2001) or ≤10mm (after 2001). Ocular exam findings were extracted from the 494 available records of patients with cGVHD.
Diagnosis of cGVHD was made in 494 of 704 patients (70.2%). Mean follow up was 979 days post transplantation (range 58-6089). Conjunctival injection was noted in 10.5% of patients, chemosis in 3.64%, and either pseudomembrane formation or epithelial sloughing in 0.61%. Symblepharon was not noted among these patients, and subepithelial fibrosis was noted in 0.40% of patients. Fluorescein corneal staining was observed in 30.6% of patients. Posterior subcapsular cataracts were seen in 26.9% of patients. The prevalence of aqueous tear deficiency was 23.3% at first eye exam. Of the 494 patients, 277 returned for further follow up. Prevalence of dry eye at the last eye exam was 36.8%. Average visual acuity at the first visit was 20/27 (range 15-CF) and 20/29 (range 10-LP) at the last visit. Only 1 patient had visual acuity of lower than 20/200 from corneal scarring resulting from BMT-related aqueous tear deficiency. At last follow up, 93.7% of patients had at least one eye with visual acuity of 20/30 or better. Bone marrow transplantation related retinal findings were rare, the most common being hemorrhage due to thrombocytopenia.
We determined that prevalence of ocular findings in allogeneic BMT patients with cGVHD had infrequent conjunctival involvement. Conjuntival involvement in this patient population may have been overstated in previous studies. However, corneal staining and aqueous tear deficiency were frequently noted. Most importantly, the majority of patients had excellent visual acuity, despite the high prevalence of aqueous tear deficiency; limitation in best-corrected visual acuity was often attributed to cataracts.
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