Ocular surface and lacrimal disturbances in chronic graft‐versus‐host disease: the role of conjunctival biopsy

Abstract

Forty-four patients (21 male, 23 female) were studied following bone marrow transplantation (BMT): 40 after allogeneic, one after syngeneic and three after autologous transplantation. Diffuse punctate conjunctival and corneal epitheliopathy was seen in 27 (61%), reduced or disordered tear film in 26 (59%), acquired lacrimal outflow obstruction in three (7%) and posterior subcapsular lens opacities in five (1 2%) patients. Conjunctival histology showed abnormal features, including those of graft-versus-host disease (GVHD) in 41 patients. Of these, 28 (64%) had clinical and laboratory features of GVHD and six patients with no systemic evidence of GVHD had conjunctival histology specific for GVHD.We conclude that after BMT, subclinical changes of GVHD are very common in the periocular tissues and may be universal in long-term survivors following allogeneic BMT. Some minor conjunctival changes are more likely to be due to the primary disease or the transplant conditioning regimen. Conjunctival biopsy is useful in demonstrating low-grade GVHD or GVHD confined to the ocular structures and may be diagnostic in some cases.

Conjunctival Scrape Cytology Findings in Patients with Chronic Graft-Versus-Host Disease Following Allogeneic Bone Marrow Transplantation

“…According to 1 study, conjunctival biopsy is useful in identifying low grade GVHD or GVHD confined to the ocular structures and may be diagnostic in some cases. 16 Jabs et al 17 reported conjunctival keratinization as the major histopathologic finding in BMT recipients.…”

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

“…Some minor subclinical conjunctival changes are more likely to be due to the primary disease or the transplant conditioning regimen, 16 whereas the more expressed abnormalities are considered to be a combined result of drug toxicity and GVHD. 4 The histopathologic features of the lacrimal gland in dry eye as part of cGVHD include fibrosis of interstitium, increased number of CD34( þ ) stromal fibroblasts attached to various inflammatory cells, and excessive production of extracellular matrix components.…”

Histological and immunohistochemical characterisation of conjunctival graft vs host disease following haematopoietic stem cell transplantation

“…Pseudo-membranes, chemosis and serosanguinous exudate of the conjunctiva, as well as severe dry-eye syndrome, are common clinical signs [7,14]. Jabs et al [7] reported that 12% of their patients with acute GvHD and 11.1% of those with chronic GvHD experienced conjunctival involvement of GvHD.…”

“…West et al proposed a classification for acute cnGvHD based exclusively on the extent of bulbar epithelial necrosis [6,14] (Table 1). Lerner's classification for cutaneous GvHD is a well-established histopathological classification for prognosis and diagnostic purposes.…”