Effect of Combined Treatment with Cyclosporine A and Cord Serum for Dry Eye Associated with Graft-Versus-Host-Disease

Jung Han Choi; Han Jin Oh; Kyung Chul Yoon

doi:10.3341/jkos.2013.54.4.587

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Choi, Oh, and Yoon: Effect of Combined Treatment with Cyclosporine A and Cord Serum for Dry Eye Associated with Graft-Versus-Host-Disease

Original Article

J Korean Ophthalmol Soc 2007;54(4):587-594.

Published online: 24 August 2007

DOI: https://doi.org/10.3341/jkos.2013.54.4.587

Effect of Combined Treatment with Cyclosporine A and Cord Serum for Dry Eye Associated with Graft-Versus-Host-Disease

Jung Han Choi, MD, Han Jin Oh, MD, Kyung Chul Yoon, 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

Received 22 June 201211 August 2012 Accepted 15 January 2013

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.

Keywords: Cyclosporin A, Dry eye, Graft-versus-host disease, Umbilical cord serum

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Figure 1.

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

Table 1.

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.

Table 2.

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.

Table 3.

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).

Table 4.

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).

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