Abstract
Purpose :
To describe implementation of oGVHD Unit with a teamwork of ophthalmologists and hematologists. A longitudional cohort was detailed evaluated concerning to incidence of GVHD, clinical features and ocular surface outcomes in allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients.
Methods :
oGVHD Unit at University of Campinas was created to gather ophthalmologists and hematologists on all patients’ care, prior to transplantation procedure, during the follow-up around day 100 than annually on regular basis and in any situation of suddenly ocular complain after allo-HSCT. O GHVD was diagnosed by both NIH Consensus criteria and International chronic ocular GHVD consensus. Evaluation of oGVHD consisted of a comprehensive protocol encompassing: Ocular Surface Disease Index (OSDI), Schirmer's test (ST), Lissamine green conjuntival staining (LCS), Corneal Fluorescein Staining (CFS), Conjunctival Hyperemia (CH), Non- Invasive Tear Breakup Time (NITBUT) and meibography. Clinical and ocular surface data were compared.
Results :
107 patients underwent allo-HSCT mainly due to leukemia, 5.33% had acute isolated GVHD and 54.2% had chronic GVHD. Mean diagnosis onset for cGVHD was 43.5±77.55. Mouth, skin and eye were the main organs involved (46.8, 37.9 and 36.5 respectively). oGHVD diagnosis numbers were quite similar using NIH and ICO GVHD consensus. OSDI scores and all parameters showed a broad variation among patients and also inter eyes, along the follow up time and were compared in the worst and better moments of clinical presentation in order to picture the disease natural history. Ocular complications involved mostly cataract, infectious keratitis, corneal perforation, uveitis, triquiasis and optic nerve infiltration. Interestingly a late onset of isolated chronic oGVHD was reported in this cohort.
Conclusions :
oGVHD is a complex and challenging disease, has diverse manifestations, with broad variation on ocular tests parameters and treatment responses and “roller coaster sensation”. oGVHD Unit lessons can be improve patients’ care, increase the identification of the systemic and ocular manifestations, minimize complications and positive impacts on treatment results.
This is a 2020 ARVO Annual Meeting abstract.