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Yael Kusne, Nandita Khera, Joanne F Shen; Ocular Severity does not predict mortality or systemic severity in chronic GVHD patients. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2243.
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© ARVO (1962-2015); The Authors (2016-present)
Ocular GVHD presents in >30% of SCT patients and results in a significant impact on quality of life. Retrospective chart review was conducted to examine ocular manifestations, systemic severity, and mortality in patients with chronic GVHD.
21 subjects with ocular manifestations of chronic GVHD were evaluated by a single ophthalmologist using OSDI, conjunctival injection severity, corneal fluorescein vital dye staining, Schirmer’s testing without anesthesia, severity of conjunctival subepithelial fibrosis (CSEF) and meibomian gland atrophy (MGA) by infrared meibography. Infrared meibography images were scored using ImageJ to determine percent of MGA. CSEF was scored by a single ophthalmologist. International Consensus of Chronic Ocular GVHD (ICCG) scores were calculated for each patient using criteria previously published (Ogawa, 2013). NIH severity scores of morbidity were calculated using criteria previously published (2014). Pearson correlation coefficients were calculated for all variables.
In this cohort, mortality was 19% due to infection, malignancy relapse and GVHD. There was no correlation between ocular scores and mortality or between NIH scores and mortality. NIH scores did not correlate with ICCG scores (r=0.06), nor with MGA (r=0.06) or CSEF (r=0.03).
The NIH severity score is used to assess systemic manifestations of chronic GVHD with inclusion of multiple organ systems. In 2013, the development of the ICCG score aimed at providing further specificity for ocular findings in chronic GVHD. Here, we found that NIH severity score does not predict measured ocular manifestations including ICCG score, MGA or CSEF, as would be hypothesized, highlighting the variability of organ involvement in GVHD. Additionally, NIH severity score was not correlated to mortality in this GVHD patient cohort. Ocular symptom severity, measured by ICCG score, MGA or CSEF, was also not correlated with mortality. This data is in line with recent previously published data indicating that ocular GVHD does not infer a worse prognosis.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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