Prevalence of ocular hypertension and glaucoma in patients with chronic ocular graft-versus-host disease

Abstract

Purpose To evaluate the prevalence of ocular hypertension (OHT) and glaucoma in patients with chronic ocular graft-versus-host disease (GVHD). Methods We performed a retrospective chart review of 218 patients diagnosed with chronic ocular GVHD. Ocular hypertension was defined as intraocular pressure (IOP) ≥ 24 mm Hg in either eye without any glaucomatous optic disc changes. Glaucoma suspect was defined as optic disc changes with a cup-disc ratio ≥ 0.7 in either eye or asymmetry of ≥ 0.3 between the two eyes. Glaucoma was defined by glaucomatous optic disc changes plus glaucomatous visual field defects in two consecutive reliable visual field tests. Number of cases of ocular hypertension, glaucoma, and glaucoma suspects was evaluated. Results Thirty-three patients (15%) were diagnosed with OHT, eight patients (3.6%) with suspicion of glaucoma, and one patient (0.4%) with glaucoma. OHT occurred within six months of developing ocular GVHD in 60% of the cases and within the first year in 76%. High IOP normalized in 67% of patients when the dosage of topical or systemic corticosteroids was lowered, and 27% of patients required anti-glaucoma therapy. Conclusion Ocular hypertension is a common complication in patients with ocular GVHD, with a prevalence of 15%. The rise in intraocular pressure is often transient and resolves with management of corticosteroids in most cases. However, clinicians should be aware that nearly one-third of the patients with OHT might require anti-glaucoma treatment. The prevalences of glaucoma and suspicion of glaucoma were not higher than in the general population.

Sjögren's Syndrome, Non-Sjögren's Syndrome, and Graft-Versus-Host Disease Related Dry Eye

“…88 Glaucoma, cataract, infection, and corneal perforation should be prevented as side effects that occur after topical or systemic corticosteroid administration for preventing or treating GVHD. 89 Meibomian gland dysfunction is the second-most frequent ocular complication after HSCT. Approximately 48% of recipients develop HSCT.…”

Non-GVHD ocular complications after hematopoietic cell transplantation: expert review from the Late Effects and Quality of Life Working Committee of the CIBMTR and Transplant Complications Working Party of the EBMT

“…65 In a study of 218 patients with chronic GVHD, 33 (15%) had increased intraocular pressure, 8 (3.6%) had suspicion of glaucoma, and 1 (0.4%) had glaucoma. 66 Classically, glaucoma is known as a late complication of irradiation used in conditioning regimens, with a median interval of 22 months to onset of glaucoma. 67 Long-term use of systemic corticosteroids for chronic GVHD can elevate intraocular pressure in susceptible patients.…”

“…67 Long-term use of systemic corticosteroids for chronic GVHD can elevate intraocular pressure in susceptible patients. 66,68,69 The risk of early intraocular pressure rise and amount of elevation are greater in children than adults. 70 Intraocular pressure may be elevated even after topical steroid use such as eye drops, ointment and inhalation.…”

“…A rise in intraocular pressure is often transient and resolves within 4 weeks of tapering or cessation of systemic steroid therapy. 66 If steroid use exceeds 18 months, the intraocular pressure may be permanently elevated. First-line treatment of glaucoma is topical aqueous humor suppressants, including beta-blockers, alpha 2 agonists, or carbonic anhydrase inhibitors.…”

“…Systemic corticosteroids accelerate cataract formation 13,14,85 and glaucoma development. 66 Topical corticosteroids are commonly used for treatment of ocular GVHD, but their long-term use is associated with elevated intraocular pressure, decreased epithelial healing, infection and cataracts. 18 High-potency steroid eye drops should be avoided, and intraocular pressure should be monitored in patients who continue steroid eye drops for more than 2 weeks.…”