TY - JOUR
T1 - Corneal fluorescein staining and ocular symptoms but not Schirmer test are useful as indicators of response to treatment in chronic ocular GVHD
AU - Amparo, Francisco
AU - Shikari, Hasanain
AU - Saboo, Ujwala
AU - Dana, Reza
N1 - Publisher Copyright:
© 2018
PY - 2018/7
Y1 - 2018/7
N2 - Purpose: To evaluate long-term ocular surface clinical signs and symptoms response to therapy in patients with chronic ocular GVHD. Methods: Retrospective review and data modeling. We reviewed the records of post-bone marrow transplantation patients who were newly diagnosed with ocular GVHD and initiated therapy, and analyzed changes in symptoms (Ocular Surface Disease Index [OSDI]; Symptom Assessment in Dry Eye [SANDE]) and signs (corneal fluorescein staining [CFS]; Schirmer test). We used a LOESS technique to fit a model in function of data variations and obtain a predictive value of the scores progression over time. Results: The records of 123 patients who were followed-up for over 2 years (up to 62 months) were reviewed. The median baseline scores recorded were: OSDI 52 units, SANDE 62.2 units, CFS 2.0 Oxford units, and Schirmer 4 mm. After six months of follow up, scores improved for OSDI (−18.6 units, p = 0.007), SANDE (23.7 units, p = 0.01), and CFS (−0.7 Oxford units, p < 0.001). Data analysis showed that after a 2-year follow up the three parameters continued to improve: OSDI -13.67 units (27% reduction), SANDE -17.55 units (28%), CFS -1.1 units (54%), but Schirmer test scores progressively worsened −1.2 mm (22%). Conclusion: In patients with ocular GVHD symptoms and corneal fluorescein staining improved after initiation of treatment, meanwhile Schirmer scores declined progressively. This indicates that appropriate treatment in chronic ocular GVHD can lead to mid- and long-term improvements in symptoms and corneal epitheliopathy; however, sustained reduction in Schirmer test scores suggests chronic tear production impairment.
AB - Purpose: To evaluate long-term ocular surface clinical signs and symptoms response to therapy in patients with chronic ocular GVHD. Methods: Retrospective review and data modeling. We reviewed the records of post-bone marrow transplantation patients who were newly diagnosed with ocular GVHD and initiated therapy, and analyzed changes in symptoms (Ocular Surface Disease Index [OSDI]; Symptom Assessment in Dry Eye [SANDE]) and signs (corneal fluorescein staining [CFS]; Schirmer test). We used a LOESS technique to fit a model in function of data variations and obtain a predictive value of the scores progression over time. Results: The records of 123 patients who were followed-up for over 2 years (up to 62 months) were reviewed. The median baseline scores recorded were: OSDI 52 units, SANDE 62.2 units, CFS 2.0 Oxford units, and Schirmer 4 mm. After six months of follow up, scores improved for OSDI (−18.6 units, p = 0.007), SANDE (23.7 units, p = 0.01), and CFS (−0.7 Oxford units, p < 0.001). Data analysis showed that after a 2-year follow up the three parameters continued to improve: OSDI -13.67 units (27% reduction), SANDE -17.55 units (28%), CFS -1.1 units (54%), but Schirmer test scores progressively worsened −1.2 mm (22%). Conclusion: In patients with ocular GVHD symptoms and corneal fluorescein staining improved after initiation of treatment, meanwhile Schirmer scores declined progressively. This indicates that appropriate treatment in chronic ocular GVHD can lead to mid- and long-term improvements in symptoms and corneal epitheliopathy; however, sustained reduction in Schirmer test scores suggests chronic tear production impairment.
KW - Corneal fluorescein staining
KW - Graft-vs-host disease
KW - Ocular GVHD
KW - Schirmer test
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U2 - 10.1016/j.jtos.2018.05.002
DO - 10.1016/j.jtos.2018.05.002
M3 - Article
C2 - 29763694
AN - SCOPUS:85047088356
SN - 1542-0124
VL - 16
SP - 377
EP - 381
JO - Ocular Surface
JF - Ocular Surface
IS - 3
ER -