Abstract
Purpose :
This study aims to characterize anatomical and functional changes in the ocular surface after allogeneic hematopoietic stem cell transplantation in the absence of GVHD.
Methods :
A total of 8 eyes of 4 patients with hematologic malignancies requiring HSCT were prospectively recruited for this pilot study. All patients underwent a full ophthalmic examination before and 3 months after transplantation. Examinations performed on all subjects included OSDI survey, tear matrix metalloproteinase (MMP)-9 test, tear break-up time (TBUT), corneal fluorescein staining (Oxford scale), lower lid meibomian gland dysfunction score and lower lid meibography. In addition, in vivo confocal microscopy (IVCM) imaging of the central cornea was used to evaluate morphological changes of the corneal epithelial layers, corneal nerves and presence of dendritic cells (DCs).
Results :
The mean age of patients was 42.75 ± 19.8 years, and mean follow-up was 91.25 ± 25.7 days after allo-HSCT. Four eyes of two patients patients exhibited positive results for MMP-9 test after transpantation despite all 8 eyes having tested negative for MMP-9 at baseline.
In the early-stage post transplantation, no statistically significant differences were found in the following variables when compared to baseline: OSDI score (P=0.067), TBUT (P=0.181), Schirmer’s test (P=0.059), corneal fluorescein staining score (P=0.085), meiboscore (P=0.142) and meibography (P=0.5).
IVCM images obtained from 4 eyes of 2 patients at baseline and post allo-HSCT were analyzed. There were no significant differences in epithelial wing cell density (P=0.281), epithelial basal cell density (P=0.089), subbasal nerve density (P = 0.468) and DC density (P=0.093).
Conclusions :
In our study, significant changes were not observed in the ocular surface parameters prior to and after all-HSCT. However, MMP-9 was detected in tears of 50% of eyes after transplantation in the absence of any ocular surface symptoms or clinical changes.
Although many patients are asymptomatic, severe dry eyes is a common finding after allo-HSCT in the context of oGVHD. The risk of oGVHD development is elevated in the first year of transplant, and there is substantial evidence that the ocular surface and meibomian glands are damaged in patients with this condition. Further study is required to determine what role, if any, the presence of MMP-9 plays in early detection of oGVHD.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.