Ophthalmic Findings in Graft Versus Host Disease

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Ophthalmic Findings in Graft Versus Host Disease

• Sutton Eye Unit
• Epsom St Helier University
• Hospitals NHS Trust
• Dr William R Tucker
• Dr Saruban Pasu
• Miss Andrena McElvanney

The authors have no financial interest in the
subject matter or products described in this
presentation
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Purpose

• To describe the clinical findings in a series of
  8 patients with Graft versus Host Disease (GvHD)
• The patients had previously received allogenic
  bone marrow transplant (BMT) for haematological
  malignancy

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Methods

• All 8 patients presented to Sutton Eye Unit (UK)
  from the adjoining Royal Marsden Hospital
• The Royal Marsden was the worlds first dedicated
  cancer hospital and is still a worldwide leader
  in cancer care

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Methods

• Patients presented between 2005 2009
• Referred with a presumed diagnosis of ocular GvHD
• Clinical history and examination was recorded
  with at least 6 months followup data collected
  (range 6 months to 2 years)

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Results - Demographics

• MaleFemale ratio was 11
• The average age at diagnosis was 32 (range 22
  44)
• The underlying diseases were Acute Myeloid
  Leukaemia (5 patients) and Acute Lymphoblastic
  Leukaemia (3 patients)
• Average time to presentation following BMT was
  120 days (range 14 360 days)
• 4 patients were considered to have acute GvHD
  having presented within 2 months

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Results Clinical Findings

• Punctate epitheliopathy present in all patients
  and in 4 was considered severe with development
  of filaments
• Meibomian gland blockage and posterior
  belpharitis were present in 100 of patients
• Average Schirmers test result at 5 minutes was
  5mm (range 1 to 12mm)

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Results Treatment
Treatment No. of Patients
Carmellose Sodium 0.5 prn e.g. All 8 pts
White Paraffin Ointment nocte 8
Fusidic Acid 1 gel bd 8
Lid Hygeine (Hot compress, cleansing) 8
Acetylcysteine 5 qds 3
Prednisolone 0.5 tds 3
Punctal Occlusion 1
Disease Severity
At most recent follow-up the treatment regimen as
detailed above had produced improved clinical
signs and resolution of symptoms in all patients
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Conclusion

• Ocular GvHD can adversely affect the quality of
  life of many patients following BMT
• All of our cases demonstrated uncomfortable dry
  eyes with marked posterior blepharitis
• Our initial treatment regimen was well tolerated
• In our opinion specific treatment for posterior
  blepharitis in this case lid hygiene and
  Fusidic Acid 1 gel twice a day helped with the
  clinical improvement of the overall picture