Graft versus host disease: clinical evaluation, diagnosis and management

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• 作者：Edgar M. Espana (1)
  Sejal Shah (1)
  Marcony R. Santhiago (2)
  Arun D. Singh (3) (4)
  
• 关键词：Dry eye ; Ocular surface inflammation ; Stem cells transplantation ; Keratinization ; GVHD
• 刊名：Graefe's Archive for Clinical and Experimental Ophthalmology
• 出版年：2013
• 出版时间：May 2013
• 年：2013
• 卷：251
• 期：5
• 页码：1257-1266
• 全文大小：529KB
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• 作者单位：Edgar M. Espana (1)
  Sejal Shah (1)
  Marcony R. Santhiago (2)
  Arun D. Singh (3) (4)
  
  1. Department of Cornea, External Disease and Refractive Surgery, Department of Ophthalmology, University of South Florida, Tampa, FL, USA
  2. Department of Cornea, External Disease and Refractive Surgery, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
  3. Department of Ophthalmic Oncology, The Cole Eye Institute, Cleveland, OH, USA
  4. The Cole Eye Institute and Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, 44195, USA
  
• ISSN：1435-702X

文摘

Graft versus H\host disease (GVHD) can be a devastating complication following bone marrow transplantation. Acute or chronic systemic GVHD can be lethal, and severe damage of different organs and tissues can occur with both types of GVHD. Ocular involvement, either in an acute or chronic presentation, may range from mild to severe with accompanying vision loss present in 60-0?% of patients. Chronic ocular GVHD, the most common form of GVHD, affects mainly the lacrimal gland, meibomian glands, cornea and conjunctiva, mimicking other immunologically mediated inflammatory diseases of the ocular surface without specific symptoms or signs. However, dry eye disease is the main manifestation of GVHD. The long-term treatment of ocular GVHD continues to be challenging and involves a multidisciplinary approach wherein the ophthalmologist plays a major role. Besides systemic immunosuppression and ocular lubricants, topical steroids and topical cyclosporine are commonly prescribed. Newer therapeutic interventions for moderate and severe ocular GVHD include the use of serum eye drops and scleral contact lenses. In this manuscript, we review the mechanisms, clinical findings, and treatment of ocular GVHD.