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. Purpose.

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Ophthalmic Findings in Graft Versus Host Disease

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Ophthalmic findings in graft versus host disease

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


Purpose

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


Methods

Methods

  • All 8 patients presented to Sutton Eye Unit (UK) from the adjoining Royal Marsden Hospital

  • The Royal Marsden was the world’s first dedicated cancer hospital and is still a worldwide leader in cancer care


Methods1

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)


Results demographics

Results - Demographics

  • Male:Female ratio was 1:1

  • 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


Results clinical findings

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 Schirmer’s test result at 5 minutes was 5mm (range 1 to 12mm)


Results treatment

Results – Treatment

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


Conclusion

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


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