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A nightmare graft-versus-host disease

Poster Details

First Author: M.Rodríguez Calvo de Mora SPAIN

Co Author(s):    E. Espejo de los Riscos                    

Abstract Details

Purpose:

To show a severe case of graft-versus-host-disease (GVHD) with bilateral persistent epithelial defect, long-lasting stromal calcification and anterior chamber involvement.

Setting:

Tertiary reference public hospital.

Methods:

60 year old patient that received an allogenic bone marrow transplantation 6 months ago. She already showed GVHD in lungs and skin. In the first visit, she complains of excruciating pain and shows signs of GVHD and complete epithelial defects. After, she developed long-lasting stromal calcification and anterior chamber involvement. Sequential topical treatments included: antibiotics, corticosteroids, hyloparin, threalose, dexpantenol and vitamine A ointments, rich-platelet plasm, topical EDTA, cyclosporine 2% and 0.03% tacrolimus ointment. Treatment measures included: bandage contact lens, punctal plugs, bilateral amniotic membrane transplantation, attempt of removal of the calcium with EDTA obtention of anterior chamber and plaque samples.

Results:

Currently the eyes of the patient are quieter, the ocular GVHD seems to be controlled and the pain, beareable. However, the general condition of the patient is not optimal for an inmediate surgical procedure. Confirmed by histopathology, the stromal plaques are only composed by calcium. The anterior chamber reaction has subsided. A complete removal of the corneal plaques and possibly a superficial secondary lamellar keratoplasty will be awaited until it is possible to do so.

Conclusions:

GVHD is a frequent consequence of allogenic bone marrow transplantation. The severity may vary from a dry eye to a sight-threatening condition. Besides, GVHD may adopt diverse clinical forms in the anterior segment. Close monitoring of the patient and excellent communication with hematologists are mandatory for a achieving a satisfactory outcome.

Financial Disclosure:

NONE

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