Viral Keratitis in Chronic Ocular Graft-Versus-Host Disease: Virus Species and Clinical Characteristics

To investigate the virus species, risk factors and clinical characteristics of viral keratitis in patients with chronic ocular graft-versus-host disease (coGVHD).

A chart review of patients with coGVHD who visited Peking University Third Hospital between May 2020 and September 2024 was conducted. Demographic and clinical characteristics and laboratory test results were collected. Multivariate logistic regression was performed to explore the risk factors for viral keratitis. The results of viral DNA polymerase chain reaction of aqueous humor or corneal tissue were reviewed to determine the infecting virus species.

A total of 373 patients with coGVHD were included. The prevalence of viral keratitis was 4.6%. The most frequent infecting virus was cytomegalovirus (64.7%). Topical steroid use (odds ratio (OR) 8.88, 95% confidence interval (CI) 1.15-68.80; p = 0.037), systemic steroid use (OR 3.15, 95% CI 1.10-0.02; p = 0.032), and eyelid margin irregularities (OR 13.36, 95% CI 1.73-102.94; p = 0.013) were risk factors for viral keratitis. CoGVHD patients with viral keratitis presented with persistent epithelial defects, corneal ulcers and even corneal perforation. Corneal edema, keratic precipitates and neovascularization were observed. Fourteen patients underwent keratoplasty, and 4 of them had to undergo repeat keratoplasty due to corneal perforation or graft dissolution.

CMV was the most frequent infecting virus in coGVHD patients with viral keratitis. Topical and systemic steroid use and eyelid margin irregularities were identified as risk factors for viral keratitis. Viral keratitis in coGVHD patients can cause devastating vision damage, even when keratoplasty is performed.