Abstract
Purpose :
Progression of dry eye in OGVHD has not been well studied. This retrospective study evaluates change in dry eye metrics of OGVHD within 18 months after allo-HSCT.
Methods :
Retrospective review was performed for 242 patients undergoing allo-HSCT from April 2016 to November 2017. Groups included subjects with and without OGVHD. Clinical metrics were recorded at six timepoints: baseline prior to allo-HSCT and at 3, 6, 9, 12, and 18 months after allo-HSCT. Metrics included Ocular Surface Disease Index (OSDI) (0-60), corneal fluorescein staining (K-stain) (grade 0-4), conjunctival lissamine staining (grade 0-4), tear film stability by corneal topography (surface regulatory index (SRI) and irregular astigmatism index (IAI)), and Schirmer I (mm). Differences in values of each metric compared to the 3-month timepoint were calculated for each timepoint. Statistical analysis included Student's t-test and Pearson's correlation coefficient.
Results :
Twenty-seven non-OGVHD subjects and four OGVHD subjects completed evaluation at 4 or more timepoints. Significant difference was found between OGVHD and non-OGVHD groups for average OSDI (OGVHD=21.9; non-OGVHD=6.53; p<0.01) and for average SRI (OGVHD=0.72; non-OGVHD=0.36; p<0.01). For OGVHD, strong positive correlation was found between OSDI vs. SRI (R=+0.77) and moderate positive correlation between OSDI vs. IAI (R=+0.57), K-stain vs. SRI (R=+0.60), and K-stain vs. IAI (R=+0.64); non-OGVHD showed no correlation. Change in K-stain from the 3-month timepoint compared to months after allo-HSCT showed moderate positive correlation for OGVHD (+1.91 K-stain per month; R=+0.52) and no correlation for non-OGVHD. Significant difference between OGVHD and non-OGVHD was observed for change in K-stain (OGVHD=+0.77; non-OGVHD=-0.07; p<0.01). Change in Schirmer score from the 3-month timepoint compared to months after allo-HSCT showed moderate negative correlation for OGVHD (-0.31mm per month; R=-0.400); weak correlation was found in the non-OGVHD group. For all comers, there was moderate correlation between OSDI vs. K-stain (R=+0.55) and OSDI vs. lissamine staining (R=+0.43).
Conclusions :
In OGVHD over time, K-stain increased and Schirmer score decreased at a predictable rate within the first 18 months. Symptoms correlated with K-stain, tear film stability, and conjunctival staining.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.