Purchase this article with an account.
S.K. Kim, D.R. Couriel, S. Ghosh, S.C. Pflugfelder; Superior Limbic Keratoconjunctivitis in Ocular Graft vs. Host Disease . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2661.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: To describe superior limbic keratoconjunctivitis (SLK) as a clinical manifestation associated with chronic ocular graft vs. host disesase (GVHD) from a tertiary cancer hospital. Methods: 194 patients with the diagnosis of acute or chronic ocular graft vs. host disease treated at MD Anderson Cancer Center Ophthalmology Clinic between 2003–2004 were retrospectively reviewed. Cases of superior limbic keratoconjunctivitis (SLK) were identified. History of these patients including their primary malignancies, bone marrow or stem cell transplantation, systemic medication, systemic GVHD, thyroid function status, and ocular GVHD clinical history were evaluated. Literature search of clinical manifestation of ocular GVHD was performed. Results: There were 14 cases of SLK. They were all associated with patients with chronic ocular GVHD with Schirmers of <3mm without anesthetic. None of the patients had thyroid dysfunction. All patients had cicatricial conjunctival changes on the upper tarsal conjunctiva and thickened upper lids with visible telangiectasis. 2/14 patients also had fine papillae on the upper tarsal conjunctiva. All patients had systemic GVHD of one or more organs and were on varying dose of sytemic steroids, tacrolimus, and 3/14 patients were on photopheresis. Primary malignancies consisted of low grade lymphoma (1), acute myelogenous leukemia (7), mycosis fungoides (2), myelofibrosis (1), acute lymphocytic leukemia (1), chronic myelogenous leukemia (1) and non–Hodgkins lymphoma (1). 3/14 patients had total body irradiation prior to transplantation along with chemotherapy.10/14 and 4/14 cases were match–related and matched–unrelated stem cell transplantation, respectively. Patients had documented ocular GVHD (usually sicca syndrome, but ranging from hyperemia with chemosis to pseudomembranous conjunctivitis) between 4 months to 4 years post transplantation, with median of 4 months post transplantation. SLK has not been previous reported in the setting of ocular GVHD. Conclusions: SLK associated with chronic ocular GVHD is reported for the first time. This condition may be related to the upper tarsal cicatricial conjunctival disease commonly seen in chronic ocular GVHD. Further studies are necessary to elucidate its pathophysiology.
This PDF is available to Subscribers Only