Bandage Contact Lenses (BCLs) in the Management of Refractory Ocular Surface Disease Following Hematopoietic Stem Cell Transplantation(HSCT)

Abstract

Abstract: : Purpose: To present a novel and counterintuitive method for managing severe ocular surface disease (OSD) following HSCT. Methods: 5 patients with severe OSD following HSCT were identified. All patients had graft versus host disease at some time. Subjective findings included severe discomfort and vision loss. Clinical findings included vision loss, punctate keratopathy, decreased tear secretion, variable amounts of conjunctival inflammation and/or scarring especially superiorly, and multiple corneal filaments. Patients selected for the study had persistent OSD even after the use of artificial tears, topical anti–inflammatory agents, topical immunosuppressive agents, lacrimal drainage system occlusion and filament removal. Patients were offered a trial of BCL wear after being informed of the risks in patients with dry eye and inflammation. Consenting patients were fitted with BCL and followed at short intervals with subjective and objective assessments. Results: 5 of 5 patients had marked subjective improvement with BCL. Objective improvement as manifested by improved vision, decreased corneal epithelial staining, decreased inflammation and decreased filaments, was seen in 4 of 5 patients who tolerated the lenses well, to the extent that incapacitated patients returned to work. BCL wear has extended for up to 4 months in these 4 patients without complication. 2 required punctal cautery to allow extended lens wear. One patient twice experienced BCL loss followed by a large epithelial defect and BCL use was discontinued. No patient had recurrent filaments. Conclusions: The use of BCL in patients with severe refractory OSD following HSCT appears to be highly effective in providing subjective and objective relief. Despite anticipated risks of BCL wear in this setting, it appears safe though requiring extensive care.

Keywords: contact lens • cornea: tears/tear film/dry eye • transplantation