Abstract
Purpose :
Examine differences in baseline characteristics and treatment of chronic ocular graft versus host disease (oGVHD) patients in two geographically distinct locations.
Methods :
Patients diagnosed with definite chronic oGVHD as defined by the International Chronic Ocular GVHD Consensus Group between 09/2014 and 09/2021 at two locations were identified. Clinic 1 (C1) is located in Arizona and Clinic 2 (C2) is located in Minnesota. IRB approved retrospective chart review was conducted and the following data was collected for initial and follow-up visits: demographic information, ocular surface disease index (OSDI), corneal fluorescein staining (CFS), and treatment (hot compresses, moisture chambers, punctal plugs, punctal cautery, autologous serum tears (AST), and scleral contact lenses). Differences by site were tested using Chi-Square tests or linear model ANOVA.
Results :
C1 (n=79) and C2 (n=50) baseline mean age was 58.4 years and 57.5 years, respectively. Mean length of follow-up was 108.2 weeks for C1 and 115.9 weeks for C2. By last follow-up, mean OSDI change was -17.6 at C1 (95% CI -24.2, -11.1) and +5.3 (95% CI -1.4, 12.1) at C2. The difference in changes was statistically significant (p<0.001). At baseline, C1 mean CFS was significantly worse for both eyes than C2 mean CFS (OD p=0.012, OS p<0.001). By last follow-up, mean CFS OD change was -0.5 at C1 (95% CI -0.7, -0.2) and -0.1 (95% CI -0.4, 0.2) at C2. The mean CFS OS change was -0.5 (95% CI -0.7, -0.2) at C1 and +0.1 (95% CI -0.2, 0.4) at C2. The difference in changes was statistically significant for CFS OS (p=0.006) but not for CFS OD (p=0.130). Moisture chambers and scleral lenses were used in similar frequencies at C1 and C2 (14% vs 18%, 16% vs 18%, respectively). However, punctal plugs, punctal cautery, and AST were used more frequently at C1 than C2 (85% vs 60%, 67% vs 26%, 52% vs 8%, respectively).
Conclusions :
oGVHD patients at C1 were associated with significant improvement in OSDI and corneal fluorescein staining in the left eye and were also associated with more frequent use of punctal plugs, cautery, and AST. The significance of these associations is limited by the retrospective nature of this review. Greater severity of baseline CFS at C1 supports previous studies showing that desert climate is associated with more severe signs of dry eye. Future prospective studies are needed to confirm the validity of these findings.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.