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Implementation of a Multidisciplinary Eye Clinic within a Cancer Center for Patients at Risk of Ocular Graft versus
Reshmi Talwar1, Jihyun J Min1, Desai Oula1
1Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland.
Objective:
Ocular graft-versus-host disease (oGVHD) affects approximately 50% of patients undergoing hematopoietic stem cell transplantation (HSCT). Guidelines for monitoring patients for oGVHD development are not clearly established. An oGVHD clinic at the University of Maryland Greenebaum Comprehensive Cancer Center (UMGCCC) was established to evaluate HSCT patients at risk of developing oGVHD. The objective of this study was to examine whether an integrated eye clinic corresponded with lower odds of developing oGVHD within 2 years post-HSCT.
Design:
A single-center retrospective longitudinal cohort study.
Participants:
One hundred eighty-three patients post-HSCT were included and compared patients treated before (n = 107) and after (n = 76) the UMGCCC Clinic opening in 2021.
Methods:
Ocular graft-versus-host disease odds within 2 years post-HSCT were compared between pre-UMGCCC and post-UMGCCC groups using multivariate logistic regression. A secondary analysis evaluated ophthalmic treatments initiated at the first post-transplant visit and their associations with oGVHD incidence. Bayesian logistic regression estimated posterior probability.
Main Outcome Measures:
We assessed the odds of oGVHD 2 years post-HSCT in pre-UMGCCC and post-UMGCCC groups.
Results:
The incidence of oGVHD was 19.6% pre-UMGCCC and 11.8% post-UMGCCC, corresponding to a nominal 45% lower odds of oGVHD in the post-UMGCCC cohort (odds ratio [OR]= 0.55, 95% confidence interval [CI]: 0.24-1.28, P = 0.16). After controlling for sex, conditioning regimen, graft-versus-host disease (GVHD) prophylaxis, and systemic GVHD, the post-UMGCCC cohort demonstrated 39% lower odds of oGVHD (OR = 0.61, 95% CI: 0.25-1.49, P = 0.28). Mean corneal and conjunctival staining were lower in the post-UMGCCC versus pre-UMGCCC cohort (0.43 vs. 0.54; 95% CI: 0.12‑0.34; P = 0.36 and 0.37 vs. 0.42; 95% CI: 0.14‑0.26; P = 0.57, respectively). Bayesian logistic regression showed 86.5% posterior probability of reduced oGVHD odds. A higher proportion of post-UMGCCC patients received erythromycin, warm compresses, and eyelid scrubs (P < 0.0001). Eyelid hygiene (warm compresses and eyelid scrubs) was associated with a significant decrease in oGVHD odds (OR: 0.13, 95% CI: 0.03-0.57, P = 0.01).
Conclusions:
The opening of the UMGCCC Eye Clinic was associated with a nonsignificant reduction in oGVHD odds, corneal, and conjunctival staining in patients 2 years after HSCT. Our results support the importance of integrated eye care in reducing morbidity in patients undergoing HSCT.
Financial Disclosures:
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
