Corneal grafting and aggressive medication for corneal defects in graft-versus-host disease following bone marrow transplantation

Abstract

Purpose To evaluate the clinical outcomes of corneal grafting for severe dry eye complications in bone marrow transplant recipients. Methods Eleven eyes of nine patients with severe corneal complications of chronic graft-versus-host disease were treated from 2000 to 2005. The subjects underwent penetrating keratoplasty (n ¼ 9 eyes; seven for perforation and two for leucoma) or deep anterior lamellar keratoplasty (n ¼ 2 eyes) for deep postinflammatory stromal scarring without endothelial abnormalities. Patients were observed for graft survival, visual acuity, and postoperative complications. Results During the follow-up period (mean ¼ 21.6 months), nine grafts (82%) remained clear or almost entirely clear and gained more than two logarithmic units of best-corrected visual acuity. Two regrafts were necessary as the primary grafts became cloudy after 9 and 11 months. Persistent epithelial defects occurred in seven eyes (64%), cataract in six (55%), ocular hypertension in five (45%), corneal calcareous degeneration in two (18%), loss of clarity in two (18%), and sterile ulceration in one (9%). Conclusion Corneal grafting was effective for restoring corneal clarity and improving visual function in this series of patients. Although the complication ratio was high and some patients required regrafting, there was a clinical improvement in the majority of patients.

Therapie der okulären Graft-versus-Host-Erkrankung

“…Aufgrund der zugrunde liegenden systemischen Abstoßungsreaktion und den schweren Benetzungsstörungen ist jedoch die Komplikationsrate sehr hoch. In einer Fallserie von 11 Augen von 9 Patienten berichten Tarnawska und Wylegala von 2 Re-pKPs, rezidivierenden Epitheldefekten in 7 Augen, 2 Eintrübungen der Hornhaut und einem Hornhautulkus [38]. Auch der Einsatz von Keratoprothesen, wie der Osteoodontokeratoprothese oder einer Boston Kpro ist grundsätzlich möglich, wobei hier nur sehr wenige klinische Erfahrungen bei GvHD-Patienten vorliegen [39,40].…”

A brief account on ocular graft versus host disease

“…[ 63 ] Temporary tarsorrhaphy may be required in severe cases of DED to limit ocular surface exposure. [ 64 ] Management of cicatricial lid disease may require mucous membrane grafting or other surgical procedures. [ 65 ] Stem cell transplantation (conjunctival-limbal allografts) from the patient’s HSCT donor has been reported to be a promising modality with good long-term survival.…”

“…[ 66 ] Lamellar keratoplasty, tectonic patch grafts, and penetrating keratoplasty are performed only in a limited capacity and as a final effort, given the poor chances of graft survival. [ 64 , 67 ]…”

Update on ocular graft-versus-host disease

“…Its use has been described in acute oGVHD to restore ocular surface integrity and prevent more severe complications. [ 125 ] Severe cases of DED may even warrant a temporary tarsorrhaphy[ 126 ] to decrease ocular surface exposure. Mucous membrane grafts and skin grafts may be required for the management of cicatricial lid disease.…”

“…Allogenic limbal stem cell transplantation from the same hematopoietic stem cell donor,[ 41 43 44 127 ] lamellar keratoplasty,[ 128 ] tectonic patch grafts [ Fig. 2b ], and penetrating keratoplasty[ 126 ] are performed in a limited capacity and only as a final effort, given a poor prognosis for graft survival because of severe preexisting ocular surface inflammation. Ocular surface stem cell transplantation using conjunctival and limbal allografts obtained from the patient’s HSCT donor has been reported to be a promising treatment modality associated with good long-term survival of the graft.…”