The Effect of Systemic Steroid Therapy on Dry Eye in Hematopoietic Stem Cell Transplantated Patients

Hyung Bin Hwang; Eun Jeong Jeon; Sung Kun Chung

doi:10.3341/jkos.2008.49.6.891

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

Original Article

J Korean Ophthalmol Soc 2008;49(6):891-896.

Published online: 8 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.6.891

The Effect of Systemic Steroid Therapy on Dry Eye in Hematopoietic Stem Cell Transplantated Patients

Hyung Bin Hwang, M.D.¹, Eun Jeong Jeon, M.D., Ph.D.², Sung Kun Chung, M.D., Ph.D.^1,

¹Department of Ophthalmology, The Catholic University of Korea, St. Mary's Hospital Seoul, Korea

²Department of Ophthalmology, The Catholic University of Korea, St. Paul Hospital Seoul, Korea

Address reprint requests to Sung Kun Chung, M.D. Department of Ophthalmology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea #62 Yeouido-dong, Yeongdeungpo-gu, Seoul 150-713, Korea Tel: 82-2-3779-1243, Fax: 82-2-761-6869, E-mail: eyedoc@catholic.ac.kr

30 January 2008 Accepted 20 September 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/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Dry eye syndrome, Graft-versus-host disease, Systemic steroid therapy

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.

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.

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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