Abstract
This study aims at improving the understanding of the subjective symptoms and signs of two different clinical categories of ocular graft-versus-host disease. After reviewing and screening 193 posthematopoietic stem cell transplantation (HSCT) patients of Peking University Third Hospital, we enrolled 148 (21 acute ocular GVHD, 127 chronic ocular GVHD). Patients' subjective symptoms, ocular parameters, and typical ocular signs were collected and evaluated at the same visit. Classic acute ocular GVHD patients had variable levels of conjunctival involvement but few had keratopathy; increased mucus secretion (21 of 21, 100.0%), red eye (19 of 21, 90.5%), and lacrimation (11 of 21, 52.4%) were the characteristic symptoms. The classic chronic ocular group had severe eye dryness and further corneal lesions, including filamentary keratitis, corneal ulcer, and corneal vascularization. Eye dryness (115 of 127, 90.6%), increased fibrous secretion (53 of 127, 41.7%), photophobia (50 of 127, 39.4%), and alacrimia (45 of 127, 35.4%) were the most common symptoms. Although 44.1% (56 of 127) of these patients had a history of acute ocular GVHD episodes, most were overlooked, so they did not receive stepwise evaluation and treatment. Management of ocular GVHD is very challenging and requires cooperation among disciplines.
Highlights
Allogeneic hematopoietic stem cell transplantation is a potentially curative treatment for a variety of hematologic malignancies, and indications for HSCT could expand to other blood disorders, such as aplastic anemia, sickle cell disease, and immune disorders [1,2,3]
Graft-versus-host disease (GVHD), an immune-mediated disease caused by complex interactions between donor and recipient immune systems, is a leading cause of morbidity and mortality following HSCT [4, 6, 7]. e 2014 National Institutes of Health Consensus recognized 2 principal categories of GVHD according to clinical features rather than the temporal relationship to the time of transplantation
Records of 193 consecutive post-allo-HSCT patients examined in the Department of Ophthalmology, Peking University ird Hospital, Beijing, were reviewed, and after screening, 148 patients were enrolled in the study (Figure 1)
Summary
Allogeneic hematopoietic stem cell transplantation (alloHSCT) is a potentially curative treatment for a variety of hematologic malignancies, and indications for HSCT could expand to other blood disorders, such as aplastic anemia, sickle cell disease, and immune disorders [1,2,3]. E 2014 National Institutes of Health Consensus recognized 2 principal categories of GVHD (acute and chronic) according to clinical features rather than the temporal relationship to the time of transplantation. Acute GVHD, which is stimulated by damaged recipient tissue and amplified by donor t-cells, includes the classic manifestations of erythema, maculopapular rash, nausea, vomiting, anorexia, profuse diarrhea, ileus, and cholestatic liver disease. Broad categories of this type of GVHD include classic and late-onset acute GVHD, which occurs within 100 days after transplantation or donor lymphocyte infusion. Chronic GVHD, related to thymic damage and impaired negative selection of autoreactive t-cells, is diagnosed according to at least one diagnostic manifestation or at least one distinctive manifestation plus a pertinent biopsy, laboratory, or other tests (e.g., Schirmer’s test) in each organ [6, 8]
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