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Infectious and Noninfectious Corneal Ulcers in Ocular Graft-Versus-Host Disease: Epidemiology, Clinical
Paula A Sepulveda-Beltran1, Piero Carletti1, Victor Banda1
1From the Bascom Palmer Eye Institute, Department of Ophthalmology (P.A.S.-B., P.C., V.B., L.M., H.L., G.A., A.G., R.T.).
Insights
Corneal ulcers are a risk in chronic ocular graft-vs-host disease (coGVHD) after stem cell transplant. Infectious ulcers present a higher risk of treatment failure compared to noninfectious ones.
Area of Science:
- Ophthalmology
- Hematology
- Transplantation Medicine
Background:
- Chronic ocular graft-vs-host disease (coGVHD) is a significant complication following hematopoietic stem cell transplantation (HSCT).
- Ocular surface disease is common in coGVHD, potentially leading to severe complications like corneal ulceration.
- Understanding the incidence and risk factors for corneal ulcers in this population is crucial for timely intervention.
Purpose of the Study:
- To determine the incidence, clinical features, microbiological causes, and treatment outcomes of corneal ulcers in patients with coGVHD.
- To identify risk factors associated with the development of corneal ulcers in the coGVHD population.
- To compare outcomes between infectious and noninfectious corneal ulcers.
Main Methods:
- Retrospective cohort study of patients with coGVHD undergoing evaluation for corneal ulcers between May 2010 and November 2021.
- Data collected included demographics, clinical characteristics, microbiological findings, and treatment outcomes.
- Statistical analyses included Kaplan-Meier survival for incidence and Cox regression for risk factors; infectious vs. noninfectious ulcers were compared using t-tests and chi-squared tests.
Main Results:
- The 5- and 10-year incidences of corneal ulceration in coGVHD patients were estimated at 14% and 30%, respectively.
- Infectious ulcers (66.6%) were more common than noninfectious ulcers (33.3%).
- Risk factors for ulceration included Black race, prior ocular surgery, eyelid abnormalities, and topical steroid use, while contact lens use was protective. Infectious ulcers had higher treatment failure rates (57.1% vs. 20.0%).
Conclusions:
- Corneal ulceration is a significant complication in patients with coGVHD, with identifiable risk factors.
- Infectious etiologies are more frequent and associated with poorer therapeutic outcomes compared to noninfectious ulcers.
- Proactive management of risk factors and early diagnosis are essential for improving outcomes in coGVHD patients with corneal ulcers.
Purpose:
To evaluate the incidence, clinical characteristics, microbiological profile, and therapeutic outcomes of corneal ulcers in individuals with chronic ocular graft-vs-host disease (coGVHD).
Design:
Retrospective clinical cohort study.
Methods:
Review of individuals diagnosed with coGVHD following hematopoietic stem cell transplantation (HSCT) who were seen at the Bascom Palmer Eye Institute between May 2010 and November 2021. Baseline demographics, clinical characteristics, microbiological profile, risk factors for corneal ulceration, and treatment outcomes were collected. Etiology was deemed infectious in individuals with a positive culture or appropriate clinical scenario (presence of stromal infiltrate or hypopyon); otherwise, ulcers were presumed to be noninfectious. Treatment success was defined as reepithelialization with infiltrate resolution, and treatment failure as progression to corneal perforation or keratoplasty. Kaplan-Meier survival analysis estimated the incidence of ulceration. Cox regression analyses examined demographic and risk factors. Infectious and noninfectious ulcer groups were compared using 2-way independent t tests, 1-way analysis of variances, and χ2 tests, as appropriate.
Results:
173 individuals were included (53.7±14.4 years old; 59.0% male). Thirty-three individuals developed an ulcer 74.5±54.3 months after HSCT, with estimated 5- and 10-year incidences of 14% and 30%, respectively. Twenty-two (66.6%) ulcers were deemed infectious (15 microbiologically confirmed, 7 clinically) and 11 (33.3%) were deemed noninfectious. Risk factors for corneal ulceration included Black race (hazards ratio [HR] 2.89, 95% CI 1.30-6.42, P < .01), previous ocular surgery (HR 9.16, 95% CI 3.86-21.72, P < .01), eyelid margin abnormalities (HR 3.44, 95% CI 1.69-6.99, P < .01), and topical steroid use (HR 2.74, 95% CI 1.33-5.62, P < .01). Conversely, contact lens use reduced the risk of corneal ulceration (HR 0.29, 95% CI 0.13-0.66, P < .01). Infectious ulcers had a significantly higher frequency of treatment failure than noninfectious ulcers (57.1% vs 20.0%, P = .04).
Conclusion:
Corneal ulceration is a potential complication of coGVHD, with several clinical features identified as risk factors. Infectious ulcers had worse outcomes than noninfectious ulcers.
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