Ocular surface manifestations and features of chronic graft-versus-host disease treatment

Abstract

Background: Chronic graft-versus-host disease (cGvHD) is the most common complication after allogeneic bone marrow transplantation (ABMT). Ocular surface (OS) involvement is one of the most prevalent presentations of cGVHD. Early recognition of OS involvement can aid in better management and preventionThe aim is to present three cases of the ocular surface manifestations and features of treatment of patients with cGvHD. Material and methods: From 2018 to 2023, 3 patients (female, aged 52, 32 and 26 years) with OS manifestations of cGvHD after ABMT were under observation. Chronic GvHD occurred despite receiving systemic immunosuppressive therapy after 4, 12 and 18 months. The degree of severity of OS manifestations was assessed by the index (OSDI), corneal staining with fuorescein (Oxford scale), Tear production (Schirmer test 1), TFBUT, fotodocumentation. The observation period was 4, 1.5 and 2 years. All data are presented for the frst, second, and third patient, respectively. Results: All patients had photophobia, pain syndrome and blepharospasm. OSDI increased to 100, 84.5 and 100 points. Corneal staining according to the Oxford scale showed four points on 2 eyes and 5 points on 4 eyes. Tear production in all patients was reduced and the Schirmer test showed 1 mm, 5 mm, and 2 mm. Severe dysfunction of the meibomian glands was observed on 4 eyes, a moderate–on 2 eyes, TFBUT was 2 sec, 3 sec and 4 sec. Systemic treatment of cGvHD for each patient was prescribed by a hematologist/oncologist. Local therapy included preservative-free antiseptics; tearsubstitution with hyaluronic acid and trehalose, dexpanthenol; anti-infammatory therapy (dexamethasone 0.1%, 0.1% cyclosporine), autoserum, ointments with vitamin A. oral use of doxycycline. As a result of complex long-term therapy, the condition of the OS improved in all patients, OSDI decreased to 75, 62.4, and 78.1 points, corneal staining with fuorescein did not exceed 2 points, tear production increased to 5.5 mm, 7.0 mm, and 6.0 mm, the BUT increased to 5 sec, 6 sec and 9 sec. The positive changes of the OS were accompanied by an increase in visual acuity. Conclusion: Long-term use of systemic anti-infammatory and immunosuppressive therapy in combination with local antiseptic, anti-infammatory and moisturizing therapy with preservatives-free drugs can signifcantly improve the OS and quality of life, as well as preserve the vision of patients with cGvHD.