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[Corneal complications after hematopoietic stem cell transplantation]
H Mittelviefhaus1, C Auw-Hädrich
1Universitätsaugenklinik Freiburg.
Summary
Patients undergoing hematopoietic stem cell transplantation (HSCT) with severe dry eye are at high risk for corneal complications, including infections and ulcers. Frequent eye exams are crucial, especially during immunosuppression changes.
Area of Science:
- Ophthalmology
- Hematology
- Immunology
Context:
- Severe dry eye syndrome is a common complication following hematopoietic stem cell transplantation (HSCT).
- Sjögren-like syndrome can develop post-HSCT, increasing ocular risks.
- Graft-versus-host disease (GVHD) can affect ocular structures, including the conjunctiva and lacrimal glands.
Purpose:
- To determine the incidence and clinical progression of corneal complications in patients with severe dry eye after HSCT.
- To identify risk factors and types of corneal complications in this patient population.
- To assess the role of GVHD and immunosuppressive therapy in post-HSCT ocular morbidity.
Summary:
- A study of 50 patients with Sjögren-like dry eye post-HSCT revealed that 15 (30%) developed severe corneal complications, including keratitis, trophic ulcers, and limbal stem cell insufficiency.
- One patient required eye enucleation due to severe complications.
- Conjunctival GVHD was present in 35 patients, and infectious, trophic, or toxic keratopathies were observed, often associated with immunosuppressive therapy reduction or topical treatments.
Impact:
- Highlights the significant risk of corneal complications in HSCT patients with severe dry eye.
- Underscores the need for vigilant ophthalmological monitoring in post-HSCT patients, particularly those on immunosuppressants.
- Suggests that early detection and management of ocular complications can prevent severe vision loss and preserve ocular integrity.