Abstract
PurposeTo identify the ocular surface changes of ocular graft-versus-host disease (GVHD) using anterior segment optical coherence tomography (AS-OCT) and examine the efficacy of disposable bandage soft contact lens (BSCL) treatment in ocular GVHD patients.MethodsThis study is a prospective, Phase II clinical trial. Nineteen patients diagnosed with chronic GVHD based on the NIH criteria and ocular symptoms of NIH eye score 2 or greater were enrolled. Disposable BSCL was applied to the GVHD-affected eyes with topical antibiotic coverage. Ocular exams, eye symptom surveys, and AS-OCT were performed with signed informed consent. Patients were followed for one to three months.ResultsThirty-eight eyes of 19 patients with ocular GVHD underwent BSCL treatment in this study. AS-OCT scans were done in 14 out of 19 patients. The mean best-corrected visual acuity at enrollment, 2-week, and 4-week visits was 0.180, 0.128, and 0.163 logMAR, respectively. Twenty-four out of 25 eyes (96 %) that initially presented with conjunctival inflammation, twenty-three out of 30 eyes (76.7 %) that initially presented with punctate epithelial erosion, and 8 out of 15 (53.3 %) eyes that initially presented with filamentous keratopathy showed improvement after wearing BSCL for 2 to 4 weeks. AS-OCT revealed corneal epithelial irregularity, abnormal meibomian gland orifice, and conjunctival hyperemia, in patients with ocular GVHD.ConclusionsBSCL treatment provided significant subjective and objective improvements in ocular GVHD patients. Meanwhile, we found that AS-OCT can be a promising diagnostic tool to characterize the ocular surface changes associated with ocular GVHD.
Highlights
Graft-versus-Host Disease (GVHD) is a major complication of allogenic tissue/hematopoietic stem cell transplantation [1]
The diagnosis and severity of ocular GVHD are primarily determined by the presence of ocular manifestations, such as new-onset dry, gritty, or painful eyes, keratoconjunctivitis sicca, photophobia, punctate keratopathy, and the positive Schirmer’ test [6]
The patients who experienced difficulty seeing, gritty, and/or painful eyes benefited the most from bandage soft contact lens (BSCL) treatment. This Phase II clinical trial showed the excellent outcomes of disposable BSCL treatment for ocular GVHDaffected eyes without any significant complication
Summary
Graft-versus-Host Disease (GVHD) is a major complication of allogenic tissue/hematopoietic stem cell transplantation (allo-HSCT) [1]. Ocular GVHD reportedly occurs in more than 50 % of allo-HSCT recipients with chronic GVHD [2] and significantly impairs vision-related quality of life of patients [3,4,5]. The diagnosis and severity of ocular GVHD are primarily determined by the presence of ocular manifestations, such as new-onset dry, gritty, or painful eyes, keratoconjunctivitis sicca, photophobia, punctate keratopathy, and the positive Schirmer’ test [6]. The NIH consensus proposed the NIH eye score as the ocular GVHD severity grading [7]. Japanese dry eye score is used in Japan for ocular GVHD diagnosis [8]. The international chronic ocular GVHD consensus group proposed four subjective and objective variables – the ocular surface disease index (OSDI), Schirmer’s score without anesthesia, corneal staining, and conjunctival injection – for ocular GVHD diagnosis [9]. An appropriate noninvasive ocular examination capable of characterizing the early changes of ocular GVHD has not been clearly defined
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