Journal List > J Korean Ophthalmol Soc > v.60(12) > 1139575

TOOLS
Beak, Ha, Yi, Yoo, Kim, and Na: Clinical Symptoms and Signs of Dry Eye Disease after Allogeneic Hematopoietic Stem Cell Transplantation
Original Article

Journal of the Korean Ophthalmological Society 2019; 60(12): 1148-1154.

Published online: 17 December 2019

DOI: https://doi.org/10.3341/jkos.2019.60.12.1148

Clinical Symptoms and Signs of Dry Eye Disease after Allogeneic Hematopoietic Stem Cell Transplantation

Jin Uk Beak, MD, Min Ji Ha, MD, Rowoon Yi, MD, Young Sik Yoo, MD, PhD, Hyun Seung Kim, MD, PhD, Kyung-Sun Na, MD, PhD

Department of Ophthalmology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Address reprint requests to Kyung-Sun Na, MD, PhD. Department of Ophthalmology, Yeouido St. Mary’s Hospital, #10 63-ro, Yeoundeungpo-gu, Seoul 07345, Korea. Tel: 82-2-3779-1052, Fax: 82-2-761-6869, drna@catholic.ac.kr

Received 18 April 2019       Revised 16 May 2019       Accepted 6 December 2019

©2019 The Korean Ophthalmological Society

The Korean Ophthalmological Society

(open-access):

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 identify the symptoms and signs of patients with dry eye disease (DED) after allogenic hematopoietic stem cell transplantation (HSCT) and analyze the correlations between these signs and symptoms.

Methods

We performed a retrospective study in 96 eyes of HSCT recipients with DED. Visual acuity, intraocular pressure, Schirmer test 1 (with anesthesia), tear osmolarity, tear break-up time, Ocular staining score (OSS, Oxford), and Ocular staining disease index (OSDI) were examined before and 1, 2, and 4 months after HSCT.

Results

A significant positive correlation was noted between changes in OSS and changes in OSDI. No ocular parameters showed significant correlations with Schirmer test values. Men more frequently described alleviation of symptoms greater than their objective results compared to women.

Conclusions

Subjective symptoms alone may be insufficient when diagnosing ocular graft-versus-host disease. We recommend regular ophthalmologic examination after allo-HSCT. In addition, a baseline ocular profile of tear dynamics and ocular surface parameters should be conducted before allo-HSCT.

Keywords: Dry eye syndromes, Graft vs host disease, Hematopoietic stem cell transplantation

Figures and Tables

Table 1

Baseline characteristics of patients before allogeneic HSCT

jkos-60-1148-i001

‘Ocular GVHD (−)’ means patients without ocular GVHD, ‘Ocular GVHD (+)’ means patients with ocular GVHD. Values are presented as mean ± standard deviation or number (%).

HSCT = hematopoietic stem cell transplantation; GVHD = graft-vs-host-disease; BCVA = best corrected visual acuity; IOP = intraocularpressure; OSS = ocular staining score; BUT = tear break up time; OSDI = Ocular Surface Disease Index.

*Student t-test; †Fisher's exact test

Table 2

Comparison of changes in ocular surface and tear function before and after allogeneic HSCT between non-ocular and ocularGVHD groups

jkos-60-1148-i002

‘Ocular GVHD (−)’ means patients without ocular GVHD, ‘Ocular GVHD (+)’ means patients with ocular GVHD. ‘Base’ is showed beforeHSCT; ‘Post’ means 4 months after HSCT. Values are presented as number (%).

HSCT = hematopoietic stem cell transplantation; GVHD = graft-vs-host-disease; OSS = ocular staining score; BUT = tear break up time;OSDI = Ocular Surface Disease Index.

*Fisher's exact test.

Table 3

Association of ocular parameters with OSDI before and after HSCT

jkos-60-1148-i003

Values are presented as number (%) unless otherwise indicated.

OSDI = Ocular Surface Disease Index; HSCT = hematopoietic stem cell transplantation; CI = confidence interval; OSS = ocular stainingscore; BUT = tear break up time.

*Gamma coefficient.

Table 4

Association of ocular parameters with Schirmer score before and after HSCT

jkos-60-1148-i004

Values are presented as number (%) unless otherwise indicated.

HSCT = hematopoietic stem cell transplantation; CI = confidence interval; OSS = ocular staining score; BUT = tear break up time.

*Gamma coefficient.

Table 5

Baseline characteristics of groups divided by association with OSS and OSDI

jkos-60-1148-i005

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

OSS = ocular staining score; OSDI = Ocular Surface Disease Index; DM = diabetes mellitus; HTN = hypertension.

*One-way analysis of variance; †Fisher's exact test.

Notes

Conflicts of Interest The authors have no conflicts to disclose.

References

1. Ferrara JL, Levine JE, Reddy P, Holler E. Graft-versus-host disease. Lancet. 2009; 373:1550–1561.
2. Welniak LA, Blazar BR, Murphy WJ. Immunobiology of allogeneic hematopoietic stem cell transplantation. Annu Rev Immunol. 2007; 25:139–170.
3. Ogawa Y, Okamoto S, Wakui M, et al. Dry eye after haematopoietic stem cell transplantation. Br J Ophthalmol. 1999; 83:1125–1130.
4. Jagasia MH, Greinix HT, Arora M, et al. National institutes of health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. The 2014 diagnosis and staging working group report. Biol Blood Marrow Transplant. 2015; 21:389–401.e1.
5. Inamoto Y, Chai X, Kurland BF, et al. Validation of measurement scales in ocular graft-versus-host disease. Ophthalmology. 2012; 119:487–493.
6. Dietrich-Ntoukas T, Cursiefen C, Westekemper H, et al. Diagnosis and treatment of ocular chronic graft-versus-host disease: report from the German-Austrian-Swiss consensus conference on clinical practice in chronic GVHD. Cornea. 2012; 31:299–310.
7. Schiffman RM, Christianson MD, Jacobsen G, et al. Reliability and validity of the ocular surface disease index. Arch Ophthalmol. 2000; 118:615–621.
8. Lemp MA, Bron AJ, Baudouin C, et al. Tear osmolarity in the diagnosis and management of dry eye disease. Am J Ophthalmol. 2011; 151:792–798.
9. Bron AJ, Evans VE, Smith JA. Grading of corneal and conjunctival staining in the context of other dry eye tests. Cornea. 2003; 22:640–650.
10. The epidemiology of dry eye disease: report of the Epidemiology Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007; 5:93–107.
11. Filipovich AH, Weisdorf D, Pavletic S, et al. National institutes of health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant. 2005; 11:945–956.
12. Shikari H, Antin JH, Dana R. Ocular graft-versus-host disease: a review. Surv Ophthalmol. 2013; 58:233–251.
13. Balasubramaniam SC, Raja H, Nau CB, et al. Ocular graft-versus-host disease: a review. Eye Contact Lens. 2015; 41:256–261.
14. Yang S, Kim HS, Na KS. Changes in ocular surface after hematopoietic stem cell transplantation. J Korean Ophthalmol Soc. 2016; 57:1706–1713.
15. Jabs DA, Wingard J, Green WR, et al. The eye in bone marrow transplantation. III. Conjunctival graft-vs-host disease. Arch Ophthalmol. 1989; 107:1343–1348.
16. Schargus M, Meyer-ter-Vehn T, Menrath J, et al. Correlation between tear film osmolarity and the disease score of the international chronic ocular graft-versus-host-disease consensus group in hematopoietic stem cell transplantation patients. Cornea. 2015; 34:911–916.
17. Kim M, Kim HS, Na KS. Correlation between tear osmolarity and other ocular surface parameters in primary Sjögren's syndrome. Korean J Ophthalmol. 2017; 31:25–31.
18. Kan S, Acar U, Kizilgul M, et al. Tear film and ocular surface evaluation in gestational diabetes mellitus. Semin Ophthalmol. 2018; 33:402–406.
19. Khanal S, Millar TJ. Barriers to clinical uptake of tear osmolarity measurements. Br J Ophthalmol. 2012; 96:341–344.
TOOLS
Similar articles