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G.J. Lelli, S.I. Mian; Prophylactic Ophthalmic Cyclosporine Use in Patients at Risk for Dry Eye Secondary to Graft–Versus–Host Disease . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4475.
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Background: Graft–versus–host disease (GVHD) may result in severe dry eye syndrome (DES) in 45–60% of patients after hematopoietic stem cell transplantation (HSCT). Topical cyclosporine is safe and effective in treatment of routine DES, and may benefit patients with ocular GVHD. Cyclosporine inhibits T cell activation and down regulates inflammatory cytokines in the conjunctiva, both processes thought to be involved in the pathogenesis of ocular GVHD. Directing treatment at the inciting pathogenic process prior to discontinuation of systemic immunosuppression may decrease DES in ocular GVHD. Purpose: To evaluate prophylactic treatment of ophthalmic cyclosporine use in patients undergoing allogeneic HSCT. Methods: Retrospective chart review of 14 eyes of 7 patients evaluated prior to undergoing HSCT who were treated with prophylactic topical cyclosporine 0.05% twice daily (Restasis, Allergan). Results: The average length of follow–up after HSCT was 80 days (range = 36–142). Demographic data included: age (mean = 50 years, range = 38–61) and sex (male = 6, female = 1). Five patients (71%) were diagnosed with GVHD (skin and liver involvement) during the follow–up period. One patient (14%) developed worsening of subjective dry eye symptoms; the remaining 6 patients were asymptomatic. Corneal fluorescein staining worsened in 6/14 eyes (43%) and improved in 1/14 eyes (7%). Meibomian gland dysfunction was noted in all patients pre–SCT, but remained stable after SCT. Physician global assessment of patient status was deemed stable in 6 patients (86%) and worse in 1 patient (14%). No specific trends were noted in best–corrected visual acuity, basal tear secretion, intraocular pressure or conjunctival assessment. One patient (14%) noted stinging with application of topical cyclosporine. Conclusions: Ophthalmic cyclosporine appears to be safe for prophylactic treatment of patients undergoing allogeneic HSCT. While a trend of worsening corneal fluorescein staining was observed, most patients remained asymptomatic and global physician impression was stable. Longer follow–up and prospective evaluation of prophylactic topical cyclosporine is needed to further elucidate its efficacy in this subset of patients
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