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Impressum
Corneal complications after hematopoietic stem cell transplantation
Mittelviefhaus H., Auw-Hädrich C.
Dep. of Ophthalmology, University of Freiburg, Killianstr. 5, D-79106 Freiburg
Introduction: After hematopoietic stem cell transplantation a
severe dry eye syndrom can develop, which is caused by a Sjögren
like syndrome (SLS) and which frequently is associated with a graft-versus-host
(GvH) disease of the patient. We report on corneal complications in patients
with SLS.
Patients und Methods: 50 patients (age 9 to 65 y; m=42±11y)
with Sjögren like syndrom after hematopoietic stem cell transplantation
were examined. Frequency of blinking and BUT were determined. Schirmer-I,
Fluorescein-und Bengalrosatest were carried out. If a GvH reaction of
the conjunctiva was suspected conjunctival biopsy was performed.
Results: 6 patients with Sjögren like syndrom and clinical
or histological GvH reaction against skin, liver, gut or conjunctiva developed
severe corneal complications. Two patients (#1,2) with histological proven
GvH reaction of the conjunctiva developed herpetic keratitis under steroid
and cyclosporin A eye drops. One patient (#3) developed a trophic corneal
and one patient (#4) a central corneal thinning with irregular astigmatism
and loss of vision. Another patient (#5) presented with a corneal ulcer
and pseudomonas infection while being treated with a soft contact lens
and local immunosuppressive eyedrops. The eye finally had to be enucleated.
The sixth patient (#6) had a severe progressive acute GvH disease. She
developed a pseudomembranous conjunctivitis with a large corneal ulceration.
She died eight weeks later.
Discussion: The risk of ophthalmological complications increases
if GvH diseases occurs after hematopoietic stem cell transplantation.
Corneal complications may result from an agressive extension of the GvH
reaction towards the conjunctiva or the lacrimal gland. Frequently these
corneal complications are caused by the local immunosuppressive therapy:
infection as well as trophic or toxic corneal diseases (1). Therefore
we suggest that patients with hematopoietic stem cell transplantation
under local immunosuppressive therapy should frequently be checked by
an ophthalmologist. (1) Kachi S et al. (2000) Unusual corneal deposit
after the topical use of cyclosporine as eyedrops. AJO 130: 667-669.