JKOS Journal of the Korean Ophthalmological Society J Korean Ophthalmol Soc 0378-6471 2092-9374 Korean Ophthalmological Society 10.3341/jkos.2013.54.4.587 jkos-48-587 Original Article Effect of Combined Treatment with Cyclosporine A and Cord Serum for Dry Eye Associated with Graft-Versus-Host-Disease ChoiJung Han MD OhHan Jin MD YoonKyung Chul MD, PhD Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea Address reprint requests to Kyung Chul Yoon, MD, PhD Department of Ophthalmology, Chonnam National University Hospital #42 Jebong-ro, Dong-gu, Gwangju 501-757, Korea Tel: 82-62-220-6742, Fax: 82-62-227-1642, E-mail: kcyoon@chonnam.ac.kr 8 2007 24 8 2007 54 4 587 594 22 6 2012 11 8 2012 15 1 2013 Copyright © 2007 Korean Ophthalmological Society 2007 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose

To investigate the efficacy of combined treatment with 0.05% cyclosporine A and 20% umbilical cord serum eye drops for severe dry eye associated with graft-versus-host disease (GVHD).

 Methods

Eighteen patients with severe dry eye associated with GVHD were treated with 0.05% cyclosporine A and 20% umbilical cord serum eye drops (group 1, n = 16), 0.05% cyclosporine A eye drops (group 2, n = 10) or artificial tears only (group 3, n = 10). Tear film break up time (BUT), Schirmer test, tear clearance rate (TCR), and keratoepithelio pathy score were measured before and 1, 3 and 6 months after treatment.

 Results

In group 1, significant improvement was observed in tear film BUT (from 3.25 ± 1.18 s to 6.63 ± 0.96 s, p < 0.01), TCR (from 2.38 ± 0.72 to 3.13 ± 0.72, p < 0.01) and keratoepithelio pathy score (from 6.31 ± 2.15 to 0.88 ± 0.89, p < 0.01) 6 months after treatment. Compared with group 2 and group 3, group 1 showed significant improvement in BUT (3 and 6 months after treatment) and keratoepitheliopathy score (1, 3 and 6 months after treatment).

 Conclusions

Combined treatment with 0.05% cyclosporine A and 20% umbilical cord serum eye drops is effective for severe dry eye associated with GVHD.

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Comparison of tear film break up time (A), schirmer test (B), tear clearance rate (C), and keratoepitheliopathy score (D) between the groups. *Statistically difference between group 1 and group 2, †Statistically difference between group 1 and group 3, ‡Statistically difference between group 2 and group 3

Characteristics of patients with severe dry eye associated with graft-versus-host disease

Group No. Age (years) Sex Original disease SCT Duration between SCT and dry eye (months) Graft-versus-host disease other than the eyes Systemic immunosuppression
1 1 56 M Non-Hodgkin's lymphoma PBSCT 4 Skin, oral mucosa Steroid, cyclosporine A
1 2 62 M Myelodysplastic syndrome PBSCT 36 Skin, liver, intestine Steroid, cyclosporine A
1 3 19 F ALL BMT 16 Skin Cyclosporine A
1 4 26 F Aplastic anemia BMT 27
1 5 35 M AML BMT 4 Skin, oral mucosa
1 6 15 M AML BMT 45 Skin, oral mucosa Steroid
1 7 32 M AML BMT 48 Steroid, cyclosporine A
1 8 45 M Non-Hodgkin's lymphoma PBSCT 4 Skin, liver, oral mucosa Steroid, cyclosporine A
2 9 30 F AML PBSCT 7 Liver, oral mucosa Steroid
2 10 16 F AML PBSCT 4 Skin, liver Steroid, cyclosporine A
2 11 16 M AML BMT 39 Skin Steroid
2 12 42 M Non-Hodgkin's lymphoma PBSCT 11 Skin, lung, oral mucosa Cyclosporine A, tacrolimus
2 13 5 M Neuroblastoma PBSCT 9 Intestine Steroid
3 14 32 M AML PBSCT 14 Liver Steroid, cyclosporine A
3 15 45 F AML PBSCT 7 Skin, liver, oral mucosa Steroid, cyclosporine A
3 16 26 M CML BMT 24 Lung, liver, spleen Steroid, cyclosporine A
3 17 18 M ALL PBSCT 9 Lung Steroid
3 18 17 M ALL BMT 1 Skin, liver, intestine Steroid, tacrolimus

SCT = stem cell transplantation; PBSCT = peripheral blood stem cell transplantation; ALL = acute lymphoblastic leukemia; BMT = bone marrow transplantation; AML = acute myelogenous leukemia; CML = chronic myelogenous leukemia.

Tear film and ocular surface change after treatment with cyclosporine A and umbilical cord serum eye drops in severe dry eye associated with graft-versus-host disease

Before 1 month 3 months 6 months P1 P2 P3
Tear film break up time (s) 3.25 ± 1.24 4.75 ± 0.68 5.63 ± 0.62 6.63 ± 0.96 <0.01 <0.01 <0.01
Schirmer test (mm) 3.19 ± 1.33 3.38 ± 1.45 3.81 ± 1.68 3.94 ± 2.26 0.61 0.10 0.20
Tear clearance rate ((log2)-1) 2.38 ± 0.62 2.69 ± 0.95 3.13 ± 0.62 3.13 ± 0.72 0.28 0.01 <0.01
Keratoepitheliopathy score 6.31 ± 2.12 2.75 ± 1.24 1.63 ± 0.89 0.88 ± 0.89 <0.01 <0.01 <0.01

Values are mean ± SD (n = 16).

P1 = statistical values between before and 1 month after treatment; P2 = statistical values between before and 3 months after treatment; P3 = statistical values between before and 6 months after treatment.

Tear film and ocular surface change after treatment with cyclosporine A eye drops in severe dry eye associated with graft-versus-host disease

Before 1 month 3 months 6 months P1 P2 P3
Tear film break up time (s) 3.32 ± 1.34 3.90 ± 1.20 4.50 ± 0.97 5.10 ± 0.88 0.13 0.02 0.07
Schirmer test (mm) 3.10 ± 0.88 3.30 ± 1.16 3.70 ± 1.16 3.90 ± 1.10 0.52 0.08 <0.01
Tear clearance rate ((log2)-1) 2.20 ± 0.63 2.27 ± 0.79 2.63 ± 0.52 2.87 ± 0.63 0.89 0.10 0.08
Keratoepitheliopathy score 5.20 ± 1.32 4.23 ± 0.79 3.37 ± 0.67 2.52 ± 0.70 0.12 0.01 0.01

Values are mean ± SD (n = 10).

P1 = statistical values between before and 1 month after treatment; P2 = statistical values between before and 3 months after treatment; P3 = statistical values between before and 6 months after treatment.

Tear film and ocular surface change after treatment with 0.1% sodium hyaluronate eye drops in severe dry eye associated with graft-versus-host disease

Before 1 month 3 months 6 months P1 P2 P3
Tear film break up time (s) 3.55 ± 1.08 3.77 ± 1.50 3.82 ± 1.40 3.75 ± 1.16 0.57 0.50 0.57
Schirmer test (mm) 3.44 ± 1.07 3.40 ± 1.17 3.52 ± 0.92 3.65 ± 1.03 0.95 0.41 0.59
Tear clearance rate ((log2)-1) 2.33 ± 0.48 2.55 ± 0.53 2.43 ± 0.57 2.55 ± 0.53 0.16 0.66 0.41
Keratoepitheliopathy score 5.27 ± 1.03 4.41 ± 1.43 4.05 ± 1.20 3.22 ± 0.92 0.13 0.09 <0.01

Values are mean ± SD (n = 10).

P1 = statistical values between before and 1 month after treatment; P2 = statistical values between before and 3 months after treatment; P3 = statistical values between before and 6 months after treatment.