Ocular Graft-versus-Host Disease after Hematopoietic Cell Transplantation: Expert Review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation

Abstract

A B S T R A C T Ocular graft-versus-host disease (GVHD) occurs in more than one-half of patients who develop chronic GVHD after allogeneic hematopoietic cell transplantation (HCT), causing prolonged morbidity that affects activities of daily living and quality of life. Here we provide an expert review of ocular GVHD in a collaboration between transplantation physicians and ophthalmologists through the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and the Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation. Recent updates in ocular GVHD regarding pathophysiology, preclinical models, risk factors, prevention, screening, diagnosis, response criteria, evaluation measures, and treatment are discussed. Ocular GVHD involves at least 3 biological processes: lacrimal gland dysfunction, meibomian gland dysfunction, and corneoconjunctival inflammation. Preclinical models have identified several novel pathogenic mechanisms, including the renin angiotensin system and endoplasmic reticulum stress signaling, which can be targeted by therapeutic agents. Numerous studies have identified reliable tests for establishing diagnosis and response assessment of ocular GVHD. The efficacy of systemic and topical treatment for ocular GVHD is summarized. It is important that all health professionals caring for HCT recipients have adequate knowledge of ocular GVHD to provide optimal care.

Steroid-refractory chronic graft-versus-host disease: treatment options and patient management

“…A final important point for management of this case is to optimize supportive care [ 69 ], such as through the use of topical dexamethasone oral rinses together with oral nystatin to prevent/treat superimposed yeast infection for oral manifestations, application of topical betamethasone for the vulva [ 69 ], and supportive ocular treatment including the use of eye lubricant, CSP ophthalmic emulsion, ocular punctal plugs, scleral lens, and other care [ 70 ].…”

Ocular Graft-Versus-Host Disease: A Plethora of Ocular Surface Manifestation in A Multidisciplinary Unit Practice

“…Chronic graft-versus-host disease (cGVHD) occurs in 30-70% of patients underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) [1,2], usually with the clinical features of an autoimmune disease [3] and the most common organs affected are skin, mouth, gastrointestinal tract, liver and eye [3]. Ocular GVHD affects 40-60% of allo-HSCT recipients [6], and ocular complications have been found to signi cantly affect both morbidity and quality of life [7]. Ocular manifestations usually follow the involvement of other organs, such as the mouth and skin.…”

Scleral Lens and Prosthetic Replacement of the Ocular Surface Ecosystem Utilization in Ocular Graft-versus-Host Disease: A Survey Study

“… 5 This leads to corneo-conjunctival inflammation which can result in epithelial erosions, filamentary keratitis and the most severe clinical manifestations of corneal stromal ulceration, melt and perforation. 6 , 7 Patients will often experience significant pain, debilitating visual impairment and a profound decrease in their quality of life (QOL) due to the intractable nature of the disease. 8–10 For patients with chronic systemic GVHD the reported incidence of oGVHD varies, with some projections as high as 60–90%.…”