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Jimena Tatiana Carreno-Galeano, Lynette Johns, Jia Yin, Reza Dana; Therapeutic effect of topical autologous serum on ocular graft-versus-host disease associated dry eyes. Invest. Ophthalmol. Vis. Sci. 2022;63(7):1569 – A0294.
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Dry eye disease (DED) is the most common manifestation of ocular graft-versus-host disease (oGVHD) associated with significant morbidity and reduced quality of life. Persons with oGVHD have been shown to have abnormal corneal sub-basal nerves, which may play a role in the development of the disease. Autologous serum drops (ASD) are used to treat severe refractory DED due to oGVHD; however, no studies to date have investigated the effect of ASD in corneal nerves in patients with oGVHD. In this prospective observational study, we evaluate the changes in symptoms, signs and corneal sub-basal nerve density in patients with oGVHD after the use of ASD.
We studied patients with moderate-to-severe DED due to oGVHD who had failed to respond to previous treatment including lubrication, anti-inflammatory medications, and punctal occlusion. A comprehensive evaluation was done at 6 and 12 weeks after initiating ASD, including: VFQ-25, SANDE I & II, OSDI, TBUT, Corneal staining, Conjunctival staining, Schirmer Test, IVCM, and Corneal sensation. Exclusion criteria included active ocular allergies, any change in anti-inflammatory or anti-glaucoma regimen, history of contact lens wear or prosthetic replacement of the ocular surface ecosystem (PROSE), and intraocular surgery or ocular laser surgery in the three months prior to enrollment. Repeated measures analysis of variance (ANOVA) were done to test for the significance of changes. Data are reported as mean ± SD.
Twenty patients with moderate-to-severe oGVHD associated DED who initiated ASD were studied. The average age was 63.4 ± 11.2 years. Twelve were female (60%) and eight (40%) male. SANDE I score was lower at 6 weeks (38.4 ± 7.6) and 12 weeks (37.8 ± 8.2) compare to baseline (67 ± 5.3, p=0.001). There were no other significant differences in dry eye symptoms or signs. The corneal sensitivity increased at 6 week (5 ± 1.3) and 12 week (5.3 ± 0.9) follow-up, compared to baseline (3.8 ± 2.1, p= 0.01). There was also a significant difference in SNFL at 6 weeks (11,264.2 ± 5768.5) and 12 weeks (12,028.1± 5,245.8) compare to baseline (10,117.5 ± 5,927.1 mm/mm2, p=0.007).
Patients with severe refractory DED due to oGVHD treated with ASD had an increase of corneal sub-basal nerve density after 6 and 12 weeks of treatment as well as improvement of corneal sensitivity and lower frequency and severity of symptoms of DED.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
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