Acute Bilateral Corneal Perforation In Refractory Ocular Graft-Versus-Host Disease And Subsequent Control Of Disease With Topical Insulin

Graft-versus-host disease (GVHD) significantly hinders the prognosis of patients who undergo allogeneic hematopoietic stem cell transplantation. Ocular involvement is one of the most frequent in GVHD (oGVHD), manifesting primarily throughout dry eye syndrome (DES), which may progress to corneal perforation, a very rare and severe complication. In this paper, we report a clinical case of acute bilateral corneal perforation in refractory oGVHD. After treating the perforation, topical insulin was administered to control patient's recurrent corneal ulcers and DES.

Department of Ophthalmology, Centro Hospitalar de Vila Nova de Gaia/Espinho.

A 42-year-old man with a history of chronic GVHD with ocular involvement presented to the emergency department with complaints of mild pain in his right eye (RE) for three days. He was diagnosed with corneal perforation in the RE and underwent cyanoacrylate glue application followed by an inlay amniotic membrane graft transplant. After the successful integration of the membrane in the corneal stroma, the patient developed a painless central corneal ulcer in the same eye that was refractory to topical treatment. During follow-up of the RE, the patient also developed a painless acute perforation of the left eye without any precursor signs or symptoms. Fearing a quick progression of the RE ulcer, topical insulin was initiated, which led to quick re-epithelialization of the corneal ulcer and control of DES.

OGVHD may progress to corneal perforation despite adequate treatment and close follow-up, and this may be worsened by the disease-induced trigeminal neuropathy. The use of topical insulin may effectively control oGVHD, impeding the progression of the disease.