Ocular Surface And Corneal Subbasal Nerve Plexus Changes In Ocular Graft-Versus-Host Disease Patients Treated With Topical Cyclosporine

To investigate the effect of topical cyclosporine (%0.05) on the ocular surface and corneal subbasal nerve plexus in patients with chronic Ocular Graft-versus-Host Disease (oGVHD).

Chronic Graft-versus-Host disease (GVHD) is one of the most common complications of allogeneic hematopoietic stem cell transplantation (HSCT). Ocular manifestations were seen in %60-90 of patients with chronic GVHD. Typically, anterior segment is involved in oGVHD, which may cause severe visual impairment and decrease the patient’s quality of life with disease progression. Timely and appropriate treatment is crucial for these patients, which still represents a challenge.

This prospective study included 24 eyes of 24 patients with chronic oGVHD. All patients were treated twice daily with topical cyclosporine (%0.05). All subjects underwent ophthalmic examination at the baseline and 1st, 3rd, and 6th months of the treatment; corneal fluorescein staining (CFS) was evaluated. Ocular Surface Disease Index (OSDI) questionnaire was applied. Non-invasive tear break-up time (NIBUT) (Sirius, CSO, Italy) and central corneal epithelial thickness (ET) (AS-OCT, Topcon 3D OCT-1 Maestro, Japan) measurements; upper eyelid non-contact meibography (Sirius, CSO, Italy) and in-vivo confocal microscopy (ConfoScan4, Nidek, Japan) were performed. Paired t-test was used for comparative analysis.

Significant improvement was seen in CFS, NIBUT and OSDI scores at 1st, 3rd, and 6th months and in upper eyelid meiboscores at 3rd and 6th months compared to baseline (p<0.05). There was no significant change in ET, corneal subbasal nerve fiber density, nerve fiber count, and fiber tortuosity throughout the study (p>0.05).

Even though topical cyclosporine significantly improved the ocular surface and symptoms of oGVHD patients, no change was observed in corneal subbasal nerve plexus morphology. While topical cyclosporine exhibited its anti-inflammatory activity at the epithelium level, it couldn’t show its effect beneath the epithelium in the short term. Further studies are needed to evaluate the long-term effects of topical cyclosporine on corneal innervation.