Dry eye disease and meibomian gland dysfunction after allogeneic hematopoietic stem cell transplantation.

Abstract

Purpose : Cross-sectional study to (1) describe incidence, clinical features and outcome of dry eye disease (DED) and meibomian gland dysfunction (MGD) associated with ocular graft-versus-host disease (oGVHD) in allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients and (2) show the experience of the recently created oGVHD Unit.

Methods : At the University of Campinas oGVHD Unit, ophthalmologists and hematologists have evaluated together all patients prior to transplantation procedure, during the follow-up or due to ocular discomfort any time after allo-HSCT. Patients were diagnosed with cGVHD per NIH Consensus criteria. The ancillary ophthalmological examination, including Schirmer's test, Ocular Surface Disease Index (OSDI), Corneal fluorescein staining (CFS), Conjunctival hyperemia (CH), Non-invasiveTear Breakup time (NITBUT) and Meibomian Gland Dysfunction (MGD) were compared to NIH ocular score at the onset of the ocular symptoms. Clinical and ocular surface data were analysed using descriptive tools and Pearson’s test using SPSS 21 version software.

Results : cGVHD occurred in 82% of 50 allo-HSCT patients (age 54.6±8.8 yo). The median month of cGVHD onset was 7 (2-74). The median of organs involved was 3 (1-6). Mouth, skin and liver were the main organs involved (93%, 63% and 63%, respectively). The ocular involvement was present in 54% of cGVHD patients. Comparing all cGVHD, with or without ocular involvement, Schirmer < 10mm (67% p<0.0001), CH > 1 (67% p<0.0001), CSF > 1 (43% p=0.005), and OSDI > 20 (65% p<0.0001) had a significant association with oGVHD. MGD was a common finding prior to allo-HSCT.

Conclusions : By evaluating patients at oGVHD Unit we have perceived that ocular surface dysfunction is present even before the HSCT and that oGVHD diagnosis remains a challenge. Schirmer’s test, CH, CFS and OSDI might be important tools to refine the evaluation of oGVHD and should be considered in clinical trials addressing ocular involvement.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.