Clinical Aspects and Risk Factors for Ocular Alterations in Patients Submitted to Hematopoietic Progenitor Cell Transplantation

Abstract

Purpose: : Patients submitted hematopoietic progenitor cell transplant (HPCT) are at risk to develop ocular alterations, mostly dry eye. The objectives of the present study were to evaluate prevalence and risk factors of ocular complications and the safety of autologous serum tears (AST) for its treatment.

Methods: : Epidemiological and clinical data were obtained from the files of 124 patients who had undergone allogeneic HPCT. In addition, 33 HPCT patients were examined and compared to control individuals. Biochemical analysis of tears and AST was performed to evaluate bioactive substances such as IL–1beta and insulin by ELISA and RIA, respectively and microbiological analysis to evaluate AST after 30 days of use.

Results: : Cataract and retinal alterations were observed in 3.3 % and 0.8% of the patients. Dry eye manifestation occurred in 32 % and was positively correlated with age over 27 years (OR 2.5, 95% CI 1.0–6.1, P=0.05), peripheral blood progenitor cell transplant (OR 4.8, 95% CI 1.8–12.8, P=0.002), chronic graft versus host disease (GVHD) (P=0.0027), and chronic or acute myeloid leukemia versus aplastic anemia (P=0.001). Other factors investigated such as donor sex, recipient sex or sex–matched transplant, HLA compatibility, GVHD prophylaxis, antimicrobial prophylaxis and acute GVHD did not show a significant correlation. Dry mouth (OR 4.8, 95% CI: 1.9–12.8, P=0.002) and Schirmer test < 5 mm (OR 8.3, 95% CI: 2.0–34.0, P= 0.07) were predictive factors for dry eye in HPCT patients. Tears from HPCT patients and controls did not differ regarding insulin, 0.80±0.13 ng/ml and 1.18±0.60 ng/ml, respectively (P= 0.29) or IL–1beta, 24.15±14.32 pg/ml and 24.19±8.30 pg/ml, respectively (P=0.99). Microbiological analysis revealed that 6 out of 11 AST samples had variable and multiple contaminations after 30 days of use.

Conclusions: : Age, hematologic disease, transplant technique and chronic GVHD are risk factors for dry eye in HPCT patients. Schirmer test and lip biopsy are satisfactory predictive factors for dry eye. Further studies will help to establish the role of other potential risk factors for ocular complications and to detect alterations in the tear film of HPCT patients. AST contamination must be considered after longer periods of use.

Keywords: cornea: tears/tear film/dry eye