In Vivo Confocal Microscopy Reveals Cellular and Structural Abnormalities in Patients with Definite Ocular Graft-vs-Host Disease (oGVHD)

Abstract

Purpose : To evaluate and compare cellular and structural abnormalities in the cornea between patients who develop definite oGVHD after hematopoietic stem cell transplantation (HSCT) and patients who do not develop oGVHD.

Methods : Patients who received HSCT were evaluated in the University of Illinois at Chicago (UIC) Dry Eye and oGVHD Clinic and classified as having definite oGVHD or none oGVHD using the international consensus classification system based on symptom analysis, corneal staining, Schirmer’s I test, and conjunctival redness. In vivo confocal microscopy (IVCM) was performed using HRT3 RCM (Heidelberg Engineering, Franklin, MA) to evaluate the corneal epithelium, nerve plexus, and stroma. Abnormalities detected were compared between groups.

Results : Patients with definite oGVHD (n= 100 eyes) had significantly greater abnormalities in the epithelium (21% vs 4.7%; p < 0.05) as compared to none oGVHD (n=86 eyes). Epithelial abnormalities included loss of hexagonal shaped cells in a honeycomb pattern with homogenous cell border reflectivity. The number of patients with complete loss of sub basal nerve plexus was significantly greater in definite oGVHD as compared to none oGVHD (20% vs 2%; p < 0.05). Sub basal nerve plexus in definite oGVHD patients also showed increased beading of nerves and presence of spindle shaped cells in the nerve plexus area as compared to none oGVHD. The corneal stroma in definite oGVHD and none oGVHD did not show significant differences other than increased reflectivity in definite oGVHD patients.

Conclusions : Patients with definite OGVHD have significant cellular and structural abnormalities in the cornea that may include abnormal epithelium morphology, loss of corneal nerves, and presence of presumed inflammatory cells in the nerve plexus area.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.