Chronic Ocular Graft-Versus-Host Disease: A Therapeutic Challenge

Published 2024 - 42nd Congress of the ESCRS

Reference: PO158 | Type: Case Report | DOI: 10.82333/trd6-7a14

Authors: Mireia Minguell Barbero* ¹ , Miriam Barbany Rodriguez ¹ , Maria Júlia Martinez Malizia ¹ , Giorgio Lari ¹ , Irene Sassot Cladera ¹ , Marta Bové Guri ¹ , Mei Martinez Alegre ¹ , Ferran Llanas Alegre ¹ , Carlota Salvador Miras ¹ , Raquel Carré Trias ²

¹Ophthalmology,Hospital Universitari Mútua Terrassa,Terrassa,Spain, ²Optometry,Hospital Universitari Mútua Terrassa,Terrassa,Spain

Purpose

Graft-versus-host disease (GVHD) is the most frequent complication of allogenic hematopoietic stem cell transplant. It is a severe condition and can affect multiple organs and tissues. Based on a real case, we intend to report the clinical course and management of chronic ocular graft-versus-host disease (oGVHD), as it can present as a challenge, specially in advanced cases of the disease.

Setting

Department of Ophthalmology, Mútua Terrassa University Hospital, Terrassa, Barcelona, Spain.

Report of case

A 60-year-old female with high-risk pre-B acute lymphoblastic leukaemia received a bone marrow transplant. She presented acute and later chronic GVHD respectively, with clinical resolution of all except oGVHD. In this case, oGVHD presented as alterations in the ocular surface, the most common ocular manifestation in GVHD. Specifically, our patient had severe keratoconjunctivitis sicca and cicatricial conjunctivitis, as well as band keratopathy. The case was stabilized through a combination of medical and surgical treatments.

The patient, who suffered from a severe keratoconjunctivitis sicca secondary to a oGVHD, presented with a fungal keratitis resistant to intensive antifungal topical treatment. The infection was finally controlled by performing a lamellar keratoplasty. After that, she developed a neurotrophic epithelial defect which had to be treated with a combination of ocular lubricants, plasma rich in growth factors drops and topical and systemic immunosupressors. Amniotic membrane coverage was also performed along with a temporal tarsorrhaphy. After a few months, due to the formation of calcium deposits in the graft and in the deep stromal layers of the recipient, a penetrating keratoplasty, along with amniotic membrane coverage and a temporary tarsorrhaphy, was performed.

Conclusion/Take home message

Ocular GVHD is a severe disorder that requires a multidisciplinary management and a combination of different medical and surgical therapies, which will have to be individualized depending on the severity of the disease. Early diagnosis and treatment is essential to minimize its consequences.