Update on ocular graft-versus-host disease

Abstract

Ocular graft-versus-host disease (oGVHD) occurs as a complication following hematopoietic stem cell transplantation and is associated with significant ocular morbidity resulting in a marked reduction in the quality of life. With no current consensus on treatment protocols, management becomes challenging as recurrent oGVHD often refractory to conventional treatment. Most authors now diagnose and grade the disease based on criteria provided by the National Institutes of Health Consensus Conference (NIH CC) or the International Chronic oGVHD (ICCGVHD) consensus group. This article will provide an insight into the diagnostic criteria of oGVHD, its classification, and clinical severity grading scales. The inflammatory process in oGVHD can involve the entire ocular surface including the eyelids, meibomian gland, corneal, conjunctiva, and lacrimal system. The varied clinical presentations and treatment strategies employed to manage them have been discussed in the present study. The recent advances in ocular surface imaging in oGVHD patients such as the use of meibography and in vivo confocal microscopy may help in early diagnosis and prognostication of the disease. Researching tear proteomics and identification of novel potential tear biomarkers in oGVHD patients is an exciting field as they may help in objectively diagnosing the disease and monitoring the response to treatment.

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

“…However, even with in-office examination, given the wide range of signs and symptoms, this formal diagnosis can often be overlooked and is still subject to clinician bias. 20 In our study, the lack of objective data assessing and confirming oGVHD diagnosis, signs and severity, and response to treatment produces a limitation inherent to patient-recall survey studies. Future prospective survey studies could include initial objective confirmation of oGVHD as a formal diagnosis prior to allowing participation in the survey portion of the study.…”

“…The primary purpose of oGVHD treatment is to increase lubrication, reduce tear evaporation, decrease surface inflammation, and provide epithelial support. 20 SL/PDs, by design, can help achieve each of these therapeutic goals concomitantly and yet clinician utilization of them for the oGVHD patient population is still limited. This underutilization is multifactorial, likely biased by historical precedent and particularly centered around previous access and financial barriers.…”

Challenges and concepts in the diagnosis and management of ocular graft-versus-host disease

“…On the other hand, occurrence of chronic oGVHD was observed in 30%–60% in the further course after HCT ( 19 , 20 ), and in 60%–90% of patients with systemic GVHD ( 7 , 10 , 19 , 21 , 22 ). Lower incidences have been found in Asian studies ( 23–25 ). The mean latency of oGVHD after HCT is about 1.5 years ( 26 ).…”

“…While the Schirmer test is useful for diagnosing disease, it was removed from scoring recommendations, as values were not useful for follow-up due to poor correlation with symptom change ( 64 ). Due to its low reproducibility it has been removed in the revision of the 2005 NIH criteria and not been included in the 2014 NIH severity scoring, nor in the 2016 Japanese and Asian diagnostic criteria for dry eye disease ( 23 , 63 , 85 ).…”

Commentary: Ocular graft versus host disease: Need for multidisciplinary care

“…The current review article in this issue throws light on the different diagnostic criteria of ocular GVHD, the classification systems, the clinical severity scales, the recent advances in ocular surface imaging in ocular GVHD, and also all treatment modalities available. [ 6 ] With further medical advances and the indications of allogeneic HSCT expanding exponentially, every ophthalmologist should be aware of this entity and should be able to provide care to these patients when consulted by colleagues in the field of hematology and oncology.…”