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Graft Versus Host Disease Treatment Strategies in Severe Dry Eye Syndrome after Hematopoietic Stem Cell Transplantation
Mittelviefhaus H.,
Albert-Ludwigs-Universität Freiburg, Augenklinik (Freiburg)
Recent advances of stem cell research have decisively influenced the treatment of malignant hematopoietic diseases. Side effects of treatment and graft versus host reaction lead to new eye diseases, which might have considerable influence on the quality of life of the affected patients. Graft versus host disease may cause severe dry eye syndrome. However, new treatment strategies are successful and may even help in the treatment of other more frequently seen autoimmune diseases. The clinical diagnosis of graft versus host reaction against the eye is based on the characteristic and frequent blinking, on the chemosis and the typical subtarsal conjunctival scars. Furthermore, break up time, fluorescein-, bengalrosa and Schirmer tests are important as well as the histological examination of biopsy specimens. In order to improve the treatment a mucus deficiency syndrome, induced by the graft versus host reaction, should be differentiated from Sjögren-like dry eye syndrome. Treatment should be modified depending on the severity and staging of the disease by (I) intensifying tear supplementation, punctum occlusion and use of high polymeric hyaluronic acid eye drops, (II) in case of histological proven graft versus host reaction by stepwise local immunomodulation with steroids and/or cyclosporin and (III) in case of signs of aggressive general extension of the graft-versus-host reaction by intensifying the systemic immunosuppressive therapy e.g. by extending the treatment, increasing the dose or adding further immunosupressive drugs. Adequate treatment can minimise the side effects of the systemic therapy, can prevent severe corneal complications and can improve quality of life and professional reintegration of the patients.