Keratoprosthetics as a visual rehabilitation method in patients with graft-versus-host disease

Abstract

The article is concerned with the treatment of a patient with allogeneic hematopoietic stem cell transplantation (HSCT) complicated by graft-versus-host disease with severe ocular manifestations. Hematopoietic stem cell transplantation is the standard therapy for a number of hemoblastoses and hereditary blood diseases, ensures the restoration of the immune system, however, in 40–60% of cases it is complicated by the development of graft-versus-host disease, with a five-year survival rate of no more than 40%. Patient S., 22 years old, was admitted to the ophthalmological center of Saint Petersburg Multifield Hospital No. 2 in 2019 with a diagnosis of “Acute keratitis, corneal ulcer of both eyes”. History of hematopoietic stem cell transplantation in 2018, complicated by graft-versus-host disease with multiorgan damage development was present. In total during the period 2019–2022, 7 tectonic keratoplasties were performed on both eyes, as well as penetrating keratoplasty on the left eye. After inflammation setback and left eye vascularized corneal leukoma formed, in December 2022, the first stage of keratoprosthetics (installation of the support element) was performed, and in May 2023, the second stage (implantation of the optical cylinder) took place. Visual acuity in one month after the implantation of the keratoprosthesis increased from light perception to 20/100, no correction possible. The use of “classical” methods of corneal ulcer perforation treatment in patients with graft-versus-host disease is ineffective due to the severe ocular surface xerosis, and keratoprosthetics seems to be the only effective method for restoring visual functions.