Ocular Graft-Versus-Host Disease Topic Review
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CATARACT AND REFRACTIVE SURGERY (C E STARR AND A BRISSETTE, SECTION EDITORS)
Ocular Graft-Versus-Host Disease Topic Review Hazem M Mousa 1 & Christopher E Starr 2 & Matias Soifer 1 & Christian Savarain 1 & Victor L Perez 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose This review offers an informed insight on the pathophysiology of ocular graft-versus-host disease in addition to up-todate recommendations for monitoring and management. Recent Findings Ocular GVHD is estimated to affect tens of thousands of individuals in the USA. It is not known how many of these patients are aware of their condition or seek therapy for it. Diagnosis of ocular GVHD poses a difficult challenge due to the unspecific nature of the presentation. However, improvement in diagnostic criteria through available testing and updated guidelines can allow early identification promoting appropriate intervention. Summary GVHD is a systemic disease that can involve any organ including the eye. Ocular GVHD is estimated to affect 40– 60% of patients undergoing allogeneic hematopoietic stem cell transplant. The disease can result in significant morbidity and mortality and continues to pose a diagnostic challenge despite continuous revision of the available criteria. Multiple therapeutic options are available and have shown promise. Despite its systemic underlying etiology, organ-specific ocular GVHD is best treated through organ-specific topical management which allows reduction of symptoms and complications. Keywords Ocular graft-versus-host disease . Ocular GVHD . Ocular immunology . Bone marrow transplantation . Keratoconjunctivitis sicca
Introduction Hematopoietic stem cell transplant (HSCT) is a therapeutic and potentially curative option in the treatment of both benign and malignant hematologic diseases. The source of the donated graft can be from the host’s own cells (autologous), cells from an identical twin (syngeneic), or cells from other donors (allogeneic). Allogeneic grafts are often HLA-matched to the patient and can be obtained from a related or an unrelated donor. One of the common complications of allogeneic-HSCT, even in fully HLAmatched transplants, is an attack on the immunocompromised host’s tissues by the donated immune cells which is referred to
This article is part of the Topical Collection on Cataract and Refractive Surgery * Victor L Perez [email protected] 1
Department of Ophthalmology, Duke University Medical Center, Durham, NC 27705, USA
2
Department of Ophthalmology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA
as graft-versus-host disease (GVHD). Although extremely rare, cases of GVHD have also been reported in patients with autologous transplants or even solid organ transplants [1, 2]. GVHD can affect a significant portion of these patients and carries significant morbidity and mortality. It is classified into acute and chronic forms that were classically defined based on time of manifestation. However, these two form
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