Severe corneal manifestations of graft-versus-host disease: Experience of a tertiary referral center

Graft-versus-host disease (GVHD) is a common complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). GVHD may affect several organs, including ocular manifestations, ranging from dry eye syndrome to sight-threatening corneal ulceration or perforation. Limited information is available about characteristics and treatments of ocular GVHD and its relation to general prognosis. We retrospectively analyzed data from 140 patients from a tertiary ophthalmological center and confronted it with systemic data from a national bone marrow transplantation database. Most patients were treated with artificial tears, vitamin A ointment, topical anti-inflammatory agents (mostly cyclosporin and steroid drops), autologous serum eye drops, scleral lenses and punctal silicone plugs. We identified a high proportion of severe ocular manifestations, such as corneal ulceration or perforation (33 patients, 23.6 %), occurring with a median of 39 months (interquartile range (IQR): 16–96) after transplantation. Overall survival did not differ in patients with severe to non-severe ocular GVHD (5-year mortality of 8 % without and 13 % with severe ocular involvement, p = 0.53 for survival curves comparisons). Multivariate analysis revealed that male patients and HLA mismatch allo-HSCT were independently associated with an increased risk of severe ocular manifestations. Moreover, a high proportion of complications occurred after non-steroidal anti-inflammatory drug (NSAID) treatments. Patients with GVHD should therefore undergo close ophthalmological monitoring and they should not, in any case, be treated with local ocular NSAIDs, due to the severity of potential complications.