Schreiber J., Petersen H.

Department of Ophthalmology, Technical University Dresden, Fetscherstr. 74, 01307 Dresden, Germany

Introduction: The therapeutic management of malignant diseases included an increased number of allogenic bone marrow transplantations (ABMT). The donor graft mounts an immunologic response against immuno compromised host. The so called graft-versus-host-disease (GvHD) may involve numerous organ systems and well be seen from different specialists.
Patients: Between 1993 and 2001 we saw four patients with severe dray eye syndrome, as a complication of GvHD. Corneal ulcer occurred 18 to 48 month after ABMT.
Results: The follow up of the patients ranged from 14 month to 8 years. In three cases a penetrating keratoplasty a chaud was necessary, a rekeratoplasty in two cases. Under topical cyclosporin A therapy the corneas of two patients were stable for one and/or two years and failed in one case. This patients underwent repeated amniotic membrane surface reconstruction. The fourth patient received a partial conjunctival flap on the right eye with progression of the visual function and a total eye patching with a conjunctival flap of the left side 21 month ago.
Conclusion: In GvHD the incidence ranges from 20 to 50%. Because of the rapidly development of dray eye syndrome the early application of tear fluid substitution is recommended. The addition of topical cyclosporin A seems to be helpful in controlling the GvHD.

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