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M. S. Soontornvachrin, M. C. Wu, P. J. Martin, M. E. Flowers, P. A. Carpenter; Characterization of Patients With Aqueous Tear Deficiency Following Allogeneic Hematopoietic Cell Transplantation. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5309.
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To determine the prevalence of aqueous tear deficiency (ATD) in patients who have had allogeneic hematopoietic cell transplantation (HCT) for hematologic diseases, and to compare the clinical characteristics of these patients to those who did not develop aqueous tear deficiency.
Retrospective review of medical records of all patients who had allogeneic stem cell transplantation at a major tertiary-care referral center between May 1971 and July 2006. Statistical analysis was performed using the chi-squared test for categorical data.
3618 patients from age 1-72 years had bilateral Schirmer’s testing at post-transplant month 3 as part of treatment protocol, comprising the study group. The mean Schirmer’s test result was 16.5 ± 8.2 mm (range 0-35 mm). The prevalence of ATD, defined as a Schirmer’s test result averaged between both eyes ≤5 mm, was 7.5%. Patients were categorized by sex, age, donor source, HLA matching, stem cell source, underlying hematologic disease, pre-HCT treatments, post-HCT treatments, and presence of acute graft-versus-host disease (GVHD). Statistically significant differences (p < 0.05) were found in the following categories: pre-HCT total body irradiation (80.7% of ATD patients vs. 63.5% of non-ATD patients), pre-HCT busulfan administration (18.9% vs. 34.6%), post-HCT steroid administration (14.4% vs. 7.1%), and presence of severe acute GVHD (28.5% vs. 18.7%).
The prevalence of aqueous tear deficiency following allogeneic stem cell transplantation was 7.5%. These patients were more likely to have had pre-transplant total body irradiation, post-transplant steroids, and are more likely to have suffered from an episode of acute GVHD compared to those who did not have aqueous tear deficiency. These patients should be followed for the development of ocular GVHD, which has been shown in the literature to be associated with dry eye symptoms.
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