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Dry Eye Disease Is Already Present in Hematological Patients Before Hematopoietic Stem Cell Transplantation
Giuseppe Giannaccare1, Francesca Bonifazi, Mariarosaria Sessa
1*Ophthalmology Unit, DIMES Department, Alma Mater Studiorum University of Bologna and S. Orsola-Malpighi Teaching Hospital, Bologna, Italy; and†Haematology Institute "L.A. Seragnoli," DIMES Department, Alma Mater Studiorum University of Bologna and S. Orsola-Malpighi Teaching Hospital, Bologna, Italy.
Insights
Dry eye affects nearly half of patients before hematopoietic stem cell transplantation (HSCT). Ocular surface examination is crucial for early diagnosis and treatment of dry eye (DE) in these patients.
Area of Science:
- Ophthalmology
- Hematology
- Oncology
Background:
- Hematopoietic stem cell transplantation (HSCT) is a critical treatment for various hematological disorders.
- Ocular surface complications, particularly dry eye (DE), can significantly impact patient well-being and treatment outcomes.
- Pre-transplant ocular surface assessment is essential for identifying at-risk individuals.
Purpose of the Study:
- To evaluate ocular surface parameters in patients prior to HSCT.
- To determine the prevalence of dry eye disease (DE) before HSCT.
- To correlate ocular surface findings with hematological characteristics.
Main Methods:
- Retrospective analysis of prospectively collected data from 203 patients undergoing HSCT.
- Collection of demographic and hematological data (disorder type, stage).
- Assessment of ocular surface parameters including Ocular Surface Disease Index (OSDI), Schirmer test I, tear film break-up time (TBUT), corneal esthesiometry, and corneal/conjunctival staining.
Main Results:
- A significant prevalence of dry eye (DE) was observed in 42.8% of patients before HSCT.
- Older age, female sex, advanced hematological disease stage, and prior HSCT were associated with increased DE risk.
- Tear film break-up time was significantly worse in patients with chronic lymphoproliferative disorders compared to stem cell malignancy.
Conclusions:
- Dry eye disease is prevalent in patients with hematological diseases before HSCT.
- Certain hematological factors influence the occurrence of pre-transplant dry eye.
- Ophthalmological examination before HSCT is vital for early DE diagnosis and management.
Purpose:
To analyze ocular surface parameters in patients before hematopoietic stem cell transplantation (HSCT) and to correlate them with hematological characteristics.
Methods:
This is a retrospective analysis of prospectively collected data from 203 patients undergoing HSCT. Demographic data and hematological parameters (disorder type and stage) were collected from clinical charts. Ocular surface parameters (ocular surface disease index; Schirmer test I; tear film break-up time; corneal esthesiometry; and corneal and conjunctival staining) were analyzed the day before beginning the conditioning treatment for HSCT preparation.
Results:
A high prevalence of dry eye (DE) was found: 116 patients (57.2%) were diagnosed as not suffering from DE, whereas 87 patients (42.8%) were diagnosed as having DE. Of these, 26 were classified as dry eye workshot (DEWS) severity score 1, 46 as DEWS score 2, and 15 as DEWS score 3. Tear film break-up time was found to be the only parameter statistically worse in the chronic lymphoproliferative disorder group compared with the stem cell malignancy group. Older age [odds ratio (OR) 1.03], female sex (OR 2.03), advanced stage of hematological disease (OR 1.4), and previous auto- or allo-HSCT (OR 1.9) showed a significant positive association in predicting DE onset before transplantation.
Conclusions:
DE was already present in a significant number of patients suffering from hematological disease before HSCT. Some hematological parameters seemed to influence this percentage. These results highlight the role of ocular surface examination by an ophthalmologist in hematological patients before HSCT, with the aim of diagnosing and, if necessary, treating DE patients early.
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