Ocular manifestations of graft-versus-host disease: 10 years’ experience

Abstract

Purpose

To evaluate the ocular presentation, treatment, and clinical course of graft-versus-host disease (GVHD).

Design

Retrospective case series.

Participants

Two hundred and forty-nine patients with systemic GVHD were included in the study.

Methods

Ocular and systemic data were collected from 2003 to 2013.

Main outcome measures

Mortality, visual acuity, and response of ocular symptoms.

Results

Sixty-four patients had ocular manifestations (25.7%). At presentation, the mean age was 44.5 years and mean latency was 16.4 months. The most common presentations were keratoconjunctivitis sicca, cataract, blepharitis, ocular hypertension, and filamentary keratitis. Visual acuity at presentation was 20/49; at the worst point in the disease was 20/115; and at most recent visit was 20/63. When topical anti-inflammatory drops were used in addition to tears, 54.3% of patients’ ocular symptoms stabilized. When autologous serum was used in addition, 80% stabilized. The overall 10-year mortality of GVHD was 29.7%. For those with ocular involvement, it was 21.9%.

Conclusion

Systemic GVHD has a high mortality rate, but ocular involvement does not suggest a worse prognosis. The main ocular presentations were keratoconjunctivitis sicca, cataracts, and ocular hypertension. Dry eyes in this population were very severe with overall worsening in visual acuity. However, with a step-wise approach involving topical anti-inflammatory medications and autologous serum tears, ocular symptoms do improve. It is important to monitor these patients closely, as they are prone to serious ocular complications such as corneal perforation and endophthalmitis.

Keywords:

• dry eye
• keratitis
• corneal ulceration

Acknowledgments

This study was supported in part by an unrestricted grant from Research to Prevent Blindness, New York, NY, USA; and by EY-R020799.

Disclosure

The authors report no conflicts of interest in this work.