Abstract
Purpose :
Examine different modalities for treating filamentary keratitis (FK) in patients with chronic ocular graft versus host disease (oGVHD).
Methods :
Patients were identified using EPIC© SlicerDicer at Mayo Clinic in the date range 01/01/2017 to 10/12/2023, querying for ICD-10 Codes for Chronic GVHD, Filamentary Keratitis right eye, left eye, bilateral, and unspecified. Retrospective IRB approved chart review was conducted on 21 patients, and the following data was collected: demographic information, date of oGVHD diagnosis, date of FK diagnosis, modes of treatment (filament removal, punctal plugs, punctal cautery, autologous serum tears (AST), steroid drops, antibiotic drops, lubricating drops, scleral contact lenses, amniotic membrane transplant (AMT), and topical cyclosporine), and treatment outcomes (resolution vs. recurrence of filaments).
Results :
Baseline mean age for patients included in the study was 63 years (range 40-78 years). Mean length of follow-up was 25 months. At last known follow-up, 74% of patients had been successfully treated (filaments no longer present). Median time from was 2 months to resolution (mean time was 10 months.) In FK-resolved patients, modalities used were as follows: steroid drops (71%), lubricating drops (64%), AST (57%), punctal plugs (43%), scleral contact lenses (43%), antibiotic drops (36%), filament removal (29%), punctal cautery (21%), AMT (7%). and topical cyclosporine (7%). For FK-persistent patients, modalities used were as follows: filament removal (60%), lubricating drops (60%), punctal cautery (40%), steroid drops (40%), punctal plugs (20%), AST (20%), antibiotic drops (20%), scleral contact lenses (20%), and AMT (20%). A greater percentage of FK-resolved patients received 4 or more of these modalities compared to FK-persistent patients (57% vs. 20%, respectively).
Conclusions :
More aggressive multi-modality treatment was associated with a greater percentage of resolution of filamentary keratitis in oGVHD. AST, punctal plugs, topical steroids, and scleral contacts were utilized more often in FK-resolved patients. Future studies should explore these modalities in a prospective fashion for treatment of FK patients.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.