Ocular Graft-Versus-Host Disease After Allogeneic Stem Cell Transplantation

Abstract

Ocular GvHD develops in a substantial part of patients after allo-SCT and decreases the activities of daily living.

Incidence and risk factors for ocular GVHD after allogeneic hematopoietic stem cell transplantation

“…9 The incidence of ocular GVHD in transplant survivors varies, and the risk factors are not well understood owing to discrepancies in the results of various studies. [10][11][12][13] Similarly, the diagnosis of DED is complicated by the lack of objective tests with sufficient and specific clinical tools. 14 Although the Schirmer test remains the main test used by ophthalmologists to diagnose DED, it is unreliable, and its results are difficult to replicate in the clinical setting.…”

Sicca symptoms and their impact on quality of life among very long-term survivors after hematopoietic SCT

“…GVHD is a common complication of HSCT that can directly compromise salivary gland and lacrimal functions. [11][12][13] The occurrence of keratoconjunctivitis sicca has been shown to vary between 38 and 10% in HSCT recipients with and without cGVHD, respectively. 7 In addition to GVHD, HSCT may cause other long-term comorbidities, in particular infections, which may require a broad repertoire of therapeutic agents.…”

Autologous platelet lysate for treatment of refractory ocular GVHD

“…2 The local therapies most commonly used to reduce ocular inflammation and corneal lesions (corticosteroids, CsA, tacrolimus and others) in association with artificial tears, demonstrated poor tolerance and unsatisfactory response. 3,5,9 For instance, a recent meta-analysis estimated that topical lubricants provide an overall improvement that is no greater than 25% from baseline, while topical CsA achieved improvement in only 10/16 (62%) patients. 10,11 Recently, borrowing from the experience of patients with severe DES in Sjö gren's disease, 12,13 treatment with autologous serum eye drops has been proposed to treat refractory keratoconjuntivitis sicca in GVHD patients with good results, demonstrating that serum is safe and effective in the majority of patients after 4 weeks of treatment.…”

“…[2][3][4] oGVHD has protean clinical manifestations, affecting multiple parts of the eye, including conjunctiva, lacrimal gland, cornea, the lid and the vitreous. 5 It frequently develops as dry eye syndrome (DES) with a prevalence ranging from 10 to 62%, 3 presenting mainly with keratoconjunctivitis sicca, conjunctival inflammation and chronic blepharitis often associated with infectious conjunctivitis. DES complications may become irreversible and lead to permanent visual loss.…”

“…DES complications may become irreversible and lead to permanent visual loss. 3 DES is classified by the NIH consensus criteria with a scale ranging from 0 (no dry eye symptoms) to 3 (pain and visual loss significantly affecting daily living). 6 Pathophysiology is complex, and includes fibroblastic and T-lymphocytic infiltrates in the lacrimal gland with consequent deficiency in lacrimal production owing to fibrosis.…”