Abstract
Patients treated with allogeneic stem cell transplantation (allo-SCT) often develop ocular complications. To investigate the ocular findings in young long-term survivors after allo-SCT without TBI, we examined 96 patients more than 5 years after transplantation. All patients were under 30 years of age at transplantation. The mean follow-up time was 16.8 years (range 6.0–26.1 years). The study was a part of the Norwegian Allo Survivorship Study investigating health impairments in young survivors after allo-SCT. Ophthalmological examination included visual acuity, tear break-up time, corneal fluorescein staining, Schirmer I test, tear film osmolarity, biomicroscopy and dilated ophthalmoscopy. In patients with known systemic chronic GVHD (cGVHD), ocular GVHD (oGVHD) diagnosed by clinical examination was compared with diagnosis using National Institutes of Health (NIH) or International Chronic Ocular Graft-vs-Host-Disease (ICCGVHD) Consensus Group criteria. We diagnosed dry eye disease (DED) in 52 patients (54%), cataract in 3 patients (3%) and retinopathy in 1 patient (1%). Systemic cGVHD was a risk factor for DED (OR 4.40, CI 1.33–14.56, p = 0.02). Comparison of diagnostic criteria suggests that the more stringent ICCGVHD criteria can better differentiate DED from oGVHD after allo-SCT as compared with the NIH criteria.
Highlights
Haematopoietic stem cell transplantation (SCT) is an established and potentially curative treatment modality for various malignant and non-malignant haematologic diseases
The secondary aim of the study was to compare Ocular graft-versus-host disease (GVHD) (oGVHD) diagnosis based on diagnostic criteria proposed by the U.S National Institutes of Health (NIH) [19] and the International Chronic Ocular Graft-vs-Host-Disease (ICCGVHD) Consensus Group [14]
Of the 96 patients included in the analysis, 59 patients (61%) had a history of systemic acute GVHD (aGVHD) or chronic GVHD (cGVHD) and 11 patients (11%) had known ocular involvement before the study examination
Summary
Haematopoietic stem cell transplantation (SCT) is an established and potentially curative treatment modality for various malignant and non-malignant haematologic diseases. Patients treated with allo-SCT often develop graft-versus-host disease (GVHD), a potentially. Ocular GVHD (oGVHD) affects 40–60% of patients treated with allo-SCT [2,3,4,5]. The condition manifests primarily as dry eye disease (DED), with keratoconjunctivitis sicca (KCS), and resembles the clinical findings seen in other immunologically mediated inflammatory diseases of the ocular surface. Patients with DED usually experience symptoms such as redness, photophobia, foreign body sensation, excessive tearing, discharge, blurring of vision and pain [10]. The ocular surface affliction is irreversible in many cases and patients often experience a significant reduction in quality of life. Diagnosis and treatment are crucial to reduce morbidity and prevent blindness for longterm survivors
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