Management Of Ocular Graft-Versus-Host Disease: About One Case.

Graft versus Host Disease (GVHD) remains a major and serious complication of allogenic hematopoietic stem cell transplantation.The objective of the analysis of the patient's case is to discuss the clinical aspects and management of GVHD

This is the case of a young man who presented an acute ocular GVHD following a stem cell transplantation as part of the treatment of acute myeloid leukemia.

We performed a complete ophthalmological examination with BCVA measurement, an examination of the ocular surface with fluorescein and lissamine green staining and Schirmer's test  as well as a fundus examination. we performed a B-mode ultrasound

The patient had a corrected visual acuity of 1/20th , the schirmer was 2 mm/5 minutes, the BUT was 3 seconds. Examination of the ocular surface revealed severe filamentous keratitis with multiple peripheral ulcers as well as corneal neovascularization and limbal stem cell deficiency.
We administered artificial tears, topical corticosteroids as well as autologous serum eye drops. Corneal healing was obtained after 21 days, we then introduced cyclosporin A as eye drops and stopped the corticosteroids.
The outcome was favorable but the patient retained sub-epithelial corneal scars with a BCVA of 3/10.

Autologous serum and cyclosporin A eye drops improve the prognosis of the GVHD. Despite this, the prognosis remains poor and the risk of serious complications is high.