Changes in Ocular Surface after Hematopoietic Stem Cell Transplantation

Soonwon Yang; Hyun Seung Kim; Kyung-Sun Na

doi:10.3341/JKOS.2016.57.11.1706

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Yang, Kim, and Na: Changes in Ocular Surface after Hematopoietic Stem Cell Transplantation

Original Article

J Korean Ophthalmol Soc 2016;57(11):1706-1713.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/JKOS.2016.57.11.1706

Changes in Ocular Surface after Hematopoietic Stem Cell Transplantation

Soonwon Yang, MD, Hyun Seung Kim, MD, PhD, Kyung-Sun Na, MD, PhD

Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea

Address reprint requests to Kyung-Sun Na, MD, PhD Department of Ophthalmology, The Catholic University of Korea Yeouido St. Mary's Hospital, #10, 63-ro, Yeongdeungpo-gu, Seoul 07345, Korea Tel: 82-2-3779-1520, Fax: 82-2-761-6869 E-mail: drna@catholic.ac.kr

Received 11 August 2016 Revised 23 August 2016 Accepted 20 October 2016

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 evaluate the prevalence of dry eye in patients before allogeneic hematopoietic stem cell transplantation (aHSCT) and changes in ocular surface in the acute stage after aHSCT.

Methods

We evaluated 56 eyes of 28 patients after aHSCT at a tertiary hospital. All patients underwent a full ophthalmic examination at 1 month before aHSCT (baseline) and 1, 2 and 3 months after aHSCT and answered the ocular surface disease index (OSDI) questionnaire to assess ocular involvement in the form of dry eye syndrome or any other ocular manifestation at each visit. Subjects were divided into 2 groups depending on the presence of dry eye at baseline. The main outcome measures were best-corrected visual acuity, tear break-up time, corneal fluorescein staining, Schirmer test, tear osmolarity and OSDI questionnaire.

Results

Dry eye was already present in 40 eyes of 20 patients (71.4%) suffering from hematological disease before aHSCT. Tear osmolarity was significantly increased at 1, 2 and 3 months after aHSCT compared with baseline in the dry eye group (each p < 0.01). Tear osmolarity also increased at 2 months after aHSCT and tear break-up time decreased at 3 months after aHSCT, which were statistically significant (p = 0.01 and p = 0.02, respectively). Other changes in ocular surface indices were not statistically significant.

Conclusions

In the acute stage, changes in ocular surface indices such as Schirmer test and OSDI were not statistically significant. However, significant changes in tear osmolarity in both groups indicate that ophthalmic examination 1 or 2 months after aHSCT is recommended. Additionally, aggressive treatment is warranted when patients have dry eyes at baseline.

Keywords: Dry eye, Graft versus host disease, Tear osmolarity

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Table 1.

Demographics of patients who received allogenei hematopoietic stem cell transplantation

	Values
Age (years)	48.27 ± 8.81
Sex (male)	26 (46.4)
Diabetes mellitus (n)	8 (14.3)
Hypertension (n)	6 (10.7)
Hematologic diagnosis
Acute myeloid leukemia	11 (39.3)
Acute lymphoblastic leukemia	6 (21.4)
Myelodysplastic syndrome	6 (21.4)
Severe aplastic anemia	5 (17.9)

Values are presented as mean ± standard deviation or n (%).

Table 2.

Results from baseline ophthalmological examinations

Parameters	All subjects	No dry eye (16 Eyes, 28.6%)	Dry eye (40 Eyes, 71.4%)	p-value^*
CDVA (log MAR)	0.08 ± 0.27	0.06 ± 0.11	0.09 ± 0.32	0.79
	(0–2.0)	(0–0.3)	(0–2.0)
Corneal staining (Oxford score)	0.48 ± 0.63	0.38 ± 0.72	0.53 ± 0.60	0.47
	(0–2.0)	(0–2.0)	(0–2.0)
TFBUT (s)	5.43 ± 2.78	8.13 ± 1.89	4.35 ± 2.30	0.00
	(1–10)	(5–10)	(1–8)
Schirmer I test (mm)	11.39 ± 7.78	14.31 ± 7.69	10.23 ± 7.60	0.08
	(0–33)	(5–33)	(0–31)
Tear osmolarity (mOsm/L)	307.86 ± 16.45	309.25 ± 15.17	307.30 ± 17.15	0.72
	(296–378)	(296–338)	(296–378)
OSDI score	8.45 ± 8.61	3.60 ± 3.53	10.39 ± 9.29	0.00
	(0–40)	(0–9)	(0–40)

Values are presented as mean±standard deviation (range). CDVA = corrected distance visual acuity; TFBUT = tear film break-up time; OSDI = ocular surface disease index.

^* p-values were calculated using independent t-test.

Table 3.

Postoperative differences from baseline ophthalmological examinations in dry eye patients

Parameters	Baseline	Postoperative	Postoperative	Postoperative
Parameters	Baseline	1 month	2 months	3 months
CDVA (log MAR)	0.09 ± 0.32	0.09 ± 0.32	0.10 ± 0.33	0.09 ± 0.35
	(0–2.0)	(0–2.0)	(0–2.0)	(0–2.0)
Corneal staining (Oxford score)	0.53 ± 0.60	0.60 ± 0.67	0.67 ± 0.63	0.47 ± 0.61
	(0–2.0)	(0–2.0)	(0–2.0)	(0–2.0)
TFBUT (s)	4.35 ± 2.30	3.55 ± 2.50	4.08 ± 2.50	4.18 ± 2.15
	(1–8)	(1–8)	(1–8)	(1–8)
Schirmer I test (mm)	10.23 ± 7.60	12.68 ± 9.53	11.67 ± 7.65	8.32 ± 6.73
Tear osmolarity (mOsm/L)	(0–31) 307.30 ± 17.15	(5–35)320.22 ± 16.91^*	(5–28)323.17 ± 18.82^*	(1–30)324.54 ± 18.41^*
	(296–378)	(301–361)	(300–367)	(301–371)
OSDI score	10.39 ± 9.29	10.55 ± 13.58	10.56 ± 13.58	9.37 ± 10.57
	(0–40)	(0–61)	(0–61.1)	(0–34)

Values are presented as mean±standard deviation (range). CDVA = corrected distance visual acuity; TFBUT = tear film break-up time; OSDI = ocular surface disease index.

^* p < 0.05 (compared with baseline value using repeated measures ANOVA).

Table 4.

Postoperative differences from baseline ophthalmological examinations in non-dry eye patients

Parameters	Baseline	Postoperative	Postoperative	Postoperative
Parameters	Baseline	1 month	2 months	3 months
CDVA (log MAR)	0.06 ± 0.11	0.09 ± 0.16	0.11 ± 0.16	0.06 ± 0.11
	(0–0.3)	(0–0.4)	(0–0.49)	(0–0.3)
Corneal staining (Oxford score)	0.38 ± 0.72	0.38 ± 0.50	0.25 ± 0.45	0.56 ± 0.51
	(0–2.0)	(0–1.0)	(0–1.0)	(0–1.0)
TFBUT (s)	8.13 ± 1.89	7.13 ± 2.80	6.94 ± 2.35	5.94 ± 2.86^*
	(5–10)	(3–10)	(2–10)	(1–10)
Schirmer I test (mm)	14.31 ± 7.69	14.50 ± 8.93	11.75 ± 6.71	10.63 ± 6.45
	(5–33)	(5–30)	(5–28)	(5–25)
Tear osmolarity (mOsm/L)	309.25 ± 15.17	317.50 ± 9.44	325.25 ± 14.22^*	316.33 ± 11.59
	(296–338)	(302–335)	(301–347)	(301–340)
OSDI score	3.60 ± 3.53	7.85 ± 11.95	3.99 ± 3.96	6.39 ± 7.76
	(0–9)	(0–29.5)	(0–10)	(0–21.8)

Values are presented as mean±standard deviation. CDVA = corrected distance visual acuity; TFBUT = tear film break-up time; OSDI = ocular surface disease index.

^* p < 0.05 (compared with baseline value using repeated measures ANOVA).

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