Ocular graft-versus-host disease: Experience, incidence, and treatment outcomes at a university-based tertiary care ophthalmology center

Abstract

Objective

This study describes the clinical experience, incidence, and outcomes of treating chronic ocular graft-versus-host disease (oGVHD) at a tertiary care ophthalmology center.

Methods

This retrospective analysis included 413 post-hematopoietic stem cell transplant patients. Ocular GVHD was diagnosed using the international chronic oGVHD consensus group criteria. Based on the severity of the initial presentation and the topical treatment received accordingly, patients with definite oGVHD were divided into three groups: Group A received combination of steroids, serum tears, and pooled human immunoglobulin; Group B received steroids and serum tears; and Group C received steroids only. Treatment response was analyzed using Wilcoxon rank-sum and Kruskal-Wallis test.

Results

53 % of patients presented with definite oGVHD manifestations at the initial visit with 16 % of these patients presenting with only ocular manifestations of chronic GVHD. Among those initially categorized as none or probable oGVHD only 18 % progressed to definite oGVHD during the follow-up period. Patients in treatment group A and B showed significant reduction (p < 0.01) in corneal staining at follow-up compared to initial visit. However, corneal staining reduction in treatment group C did not achieve significance (p = 0.06). Visual analogue scale scores decreased in all groups, with treatment group A (p < 0.01), group B (p < 0.01), and group C (p = 0.014) each showing improvement in symptoms at follow-up compared to initial visit.

Conclusion

The high incidence of oGVHD in post-HSCT patients may be related to belated referral to eye care providers. Initiating combinatorial treatment that is based on the severity of oGVHD manifestations results in significant clinical improvement.