Abstract
Ocular graft-versus-host disease (GVHD) is a severe complication of allogenic hematopoietic stem cell transplantation (HSCT). It is a term used to describe a spectrum of signs and symptoms including ocular surface inflammation, dry eye syndrome, lacrimal and meibomian gland dysfunction. We present a case of a 73-year-old man with chronic myeloblastic leukaemia and chronic GVHD. On examination, severe corneal thinning was detected in his left eye. We performed multi-layer amniotic membrane patching of the affected area, in an ambulatory setting, without using sutures or glue, but only a bandage contact lens to keep amniotic membranes attached. Three months post-amniotic-membrane-patching symptoms improved, corneal integrity was maintained, and corneal thickness increased significantly. Multi-layer amniotic membrane patching without glue and sutures may be sufficient enough to prevent further deterioration of corneal thinning and can be safely performed as an outpatient procedure, reducing the need for tectonic corneal transplantation.
Highlights
Haematopoietic stem cell transplantation (HSCT), previously referred to as bone marrow transplantation, can be used in the treatment of immune haematologic disorders and haematologic malignancies
While sutured or glued amniotic membrane (AM) patching has been used in treating corneal thinning and severe Dry eye syndrome (DES) in cases of ocular graft-versus-host disease (GVHD), there are no reported cases in the literature of using a sutureless and glueless technique of multi-layer AM patching [5,6,7,8]; we are presenting a case where this technique had a satisfying outcome
The application of sutured, cryopreserved AM in the management of ocular GVHD has been described [6,10], but it has to be performed in an operating theatre setting
Summary
Haematopoietic stem cell transplantation (HSCT), previously referred to as bone marrow transplantation, can be used in the treatment of immune haematologic disorders and haematologic malignancies. A 73-year-old man, with a known history of ocular graft-versus-host disease and a background of chronic myeloblastic leukaemia on oral ponatinib, who had undergone two bone marrow transplantations in the past (the latter being two years ago), was referred to our department by his optician. He was complaining of ''exacerbation of his dry eye disease'', with significant pain and photophobia in his left eye. One can see the increased thickness of the epithelial layer and the overall improved structural integrity of the cornea
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