Transcript 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
• 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
• 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
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
• 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
• 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
Disease Severity
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)
+ Acetylcysteine 5% qds
+ Prednisolone 0.5% tds
+ Punctal Occlusion
8
3
3
1
At most recent follow-up the treatment regimen as detailed above had
produced improved clinical signs and resolution of symptoms in all patients
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