Journal List > J Korean Ophthalmol Soc > v.49(6) > 1008284

Hwang, Jeon, and Chung: The Effect of Systemic Steroid Therapy on Dry Eye in Hematopoietic Stem Cell Transplantated Patients

Abstract

Purpose

To evaluate the effects of systemic steroid therapy on the development of dry eye syndrome (DES) in graft-versus-host disease (GVHD) resulting from hematopoietic stem cell transplantation (HSCT) in hematologic malignancy (HM) patients.

Methods

We analyzed 108 HSCT patients. We measured tear film break‐ up time (BUT) and basal tear secretion, and checked for corneal lesions. BUT under 10 seconds and basal tear secretion under 10 mm gave a diagnosis of DES. Significant corneal lesions were also described in this gorup. We compared the clinical aspect and frequency of dry eye according to GVHD and also compared clinical aspects of dry eye in GVHD patients before and after systemic steroid therapy.

Results

Fifty-six patients (51.9%) developed GVHD, including 51 patients (91.1%) in the GVHD group and 31 patients (59.6%) in the non-GVHD group. The frequency of DES was statistically significant in the GVHD group ( p<0.05). BUT and basal tear secretions were 4.08±1.76 sec and 6.05±2.57 mm in the GVHD group and 5.37±1.83 sec and 7.08±1.54 mm. There were 32 peoples (57.1%) with corneal lesions in the GVHD group and 13 peoples (25.0%) in the non-GVHD group. Based on these results, DES was statistically significant in the GVHD group. In the GVHD group, BUT and basal tear secretion levels were 4.08±1.76 sec and 6.05±2.57 mm before systemic steroid therapy and 5.20±2.91 sec and 6.73±1.80 mm after the therapy. The difference was statistically significant ( p<0.05), so we concluded that systemic steroid therapy relieved DES. Before steroid therapy, 32 peoples (57.1%) had corneal lesions, and this number decreased to 25 peoples (44.6%) after steroid therapy. The difference was not statistically significant, but we presumed that steroid therapy improved the corneal lesions ( p>0.05).

Conclusions

The severity and frequency of DES were high in the GVHD group. At the same time, systemic steroid therapy could relieve DES in GVHD patients. Therefore, proper medical treatment and ocular examinations should be performed for HSCT patients.

References

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Figure 1.
Scatter graph illustrating of tear break-up time difference after systemic steroid therapy in dry eye patients of GVHD group (51 patients) (r=0.103, p=0.472); * BUT[1] BUT[2] = = tear break-up time before steroid treatment; tear break-up time after steroid treatment.
jkos-49-891f1.tif
Figure 2.
Scatter graph illustrating of basal tear secretion difference after systemic steroid therapy in dry eye patients of GVHD group (51 patients) (r=0.142, p=0.322); * SHM[1] SHM[2] = = basal tear secretion before steroid treatment; basal tear secretion after steroid treatment.
jkos-49-891f2.tif
Table 1.
Patient distribution of gender, age, GVHD, method of stem cell transplantation, dry eye
Gender (male:female) Age (years) GVHD* (present:absent) HSCT(ABMT:APBSC§) Dry eye (present:absent)
61:47 (56.5%:43.5%) 39.3±13.5 (13~66) ) 56:52 (51.9%:48.1%) 98:10 (90.7%:9.3%) 82:26 (75.9%:24.1%)

* graft-versus-host disease

hematologic stem cell transplantation

allogenic bone marrow transplantation; blood stem cell transplantation

§ autologous peripheral

Table 2.
Distribution of hematologic malignant disease according to the existence of GVHD
Disease
ALL AML CML§ MDS MM POEMS Syn** SAA†† Total
GVHD* group 21 19 2 11 2 0 1 56 (51.9%)
Non-GVHD* group 15 19 6 5 6 1 0 52 (48.1%)
Total 36 38 8 16 8 1 1 108

* graft-versus-host disease

acute lymphocytic leukemia

acute myeloid leukemia; chronic myeloid leukemia

myelodysplastic

multiple myeloma

** polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes syndrome

†† severe aplastic anemia; One ALL, five AML, three MM, and one POEMS synd. patients (total 10 patients) syndrome; received autologous PBSCT and the rest received allogenic BMT.

Table 3.
Distribution of dry eye patients according to existence of GVHD*
Group Dry eye patients Non-dry eye patients Total
GVHD* group 51 (91.1%) 5 (8.9%) 56
Non-GVHD* group 31 (59.6%) 21 (40.4%) 52
p-value p<0.05

* graft-versus-host disease; unpaired t-test.

Table 4.
Comparison of tear break-up time, basal tear secretion and corneal lesion in GVHD* group and non-GVHD group
Tear break-up time (seconds) Basal tear secretion (mm) Corneal lesion (patients)
GVHD* group 4.08±1.76 6.05±2.57 32 (57.1%)
Non-GVHD* group 5.37±1.83 7.08±1.54 13 (25.0%)
p-value p<0.05 p<0.05 p<0.05

* graft-versus-host disease; unpaired t-test.

Table 5.
Comparison of tear break-up time, basal tear secretion and corneal lesion in GVHD group before and after systemi steroid therapy
Tear break-up time (seconds) Basal tear secretion (mm) Corneal lesion (patients)
Before therapy 4.08±1.76 6.05±2.57 32 (57.1%)
After therapy 5.20±2.91 6.73±1.80 25 (44.6%)
p-value p<0.05 p<0.05 p>0.05

paired t-test.

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