Kavitha R Sivaraman1, Renu V Jivrajka1, Ketki Soin1, Charles S Bouchard2, Asadolah Movahedan1, Ellen Shorter1, Sandeep Jain1, Deborah S Jacobs3, Ali R Djalilian4. 1. Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL. 2. Loyola University, Department of Ophthalmology, Maywood, IL. 3. BostonSight®, Needham Heights, MA; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA. 4. Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL. Electronic address: adjalili@uic.edu.
Abstract
PURPOSE: Describe the presentation and management of superior limbic keratoconjunctivitis (SLK)-like inflammation and secondary limbal stem cell dysfunction in the setting of ocular chronic graft-versus-host disease (cGVHD). METHODS: Retrospective observational case series in a multicenter clinical practice. Participants were 13 patients (26 eyes) with ocular cGVHD and SLK-like inflammation presenting to the University of Illinois at Chicago and BostonSight® between January 1, 2009 and July 1, 2013. MAIN OUTCOME MEASURES: 1) Reversal or worsening of SLK, and 2) development of limbal stem cell dysfunction. RESULTS: All eyes showed evidence of SLK-like inflammation and superior limbal stem cell dysfunction manifested by conjunctival injection and superior conjunctival and corneal staining. In addition to aggressive lubrication, management strategies for SLK included topical steroids (20/26), punctal occlusion (18/26), topical cyclosporine (24/26), autologous serum tears (12/26), therapeutic soft contact lens (13/26 eyes) and scleral lenses (4/26 eyes). SLK and limbal stem cell dysfunction were reversed in 23/26 eyes. Three eyes of two patients with long-standing disease demonstrated frank limbal stem cell deficiency (LSCD) and corneal pannus, with one patient requiring multiple reconstructive surgical procedures. CONCLUSIONS: SLK-like inflammation is an under-recognized condition in patients with severe dry eyes secondary to ocular cGVHD. Untreated SLK can potentially lead to permanent LSCD over time. Early recognition and management of SLK in ocular cGVHD can improve vision, reverse signs, and may prevent these long-term consequences.
PURPOSE: Describe the presentation and management of superior limbic keratoconjunctivitis (SLK)-like inflammation and secondary limbal stem cell dysfunction in the setting of ocular chronic graft-versus-host disease (cGVHD). METHODS: Retrospective observational case series in a multicenter clinical practice. Participants were 13 patients (26 eyes) with ocular cGVHD and SLK-like inflammation presenting to the University of Illinois at Chicago and BostonSight® between January 1, 2009 and July 1, 2013. MAIN OUTCOME MEASURES: 1) Reversal or worsening of SLK, and 2) development of limbal stem cell dysfunction. RESULTS: All eyes showed evidence of SLK-like inflammation and superior limbal stem cell dysfunction manifested by conjunctival injection and superior conjunctival and corneal staining. In addition to aggressive lubrication, management strategies for SLK included topical steroids (20/26), punctal occlusion (18/26), topical cyclosporine (24/26), autologous serum tears (12/26), therapeutic soft contact lens (13/26 eyes) and scleral lenses (4/26 eyes). SLK and limbal stem cell dysfunction were reversed in 23/26 eyes. Three eyes of two patients with long-standing disease demonstrated frank limbal stem cell deficiency (LSCD) and corneal pannus, with one patient requiring multiple reconstructive surgical procedures. CONCLUSIONS: SLK-like inflammation is an under-recognized condition in patients with severe dry eyes secondary to ocular cGVHD. Untreated SLK can potentially lead to permanent LSCD over time. Early recognition and management of SLK in ocular cGVHD can improve vision, reverse signs, and may prevent these long-term consequences.
Authors: Alexandra H Filipovich; Daniel Weisdorf; Steven Pavletic; Gerard Socie; John R Wingard; Stephanie J Lee; Paul Martin; Jason Chien; Donna Przepiorka; Daniel Couriel; Edward W Cowen; Patricia Dinndorf; Ann Farrell; Robert Hartzman; Jean Henslee-Downey; David Jacobsohn; George McDonald; Barbara Mittleman; J Douglas Rizzo; Michael Robinson; Mark Schubert; Kirk Schultz; Howard Shulman; Maria Turner; Georgia Vogelsang; Mary E D Flowers Journal: Biol Blood Marrow Transplant Date: 2005-12 Impact factor: 5.742
Authors: Asadolah Movahedan; Neda Afsharkhamseh; Hossein M Sagha; Jarna R Shah; Behrad Y Milani; Farnoud Y Milani; Hercules D Logothetis; Chi-Chao Chan; Ali R Djalilian Journal: PLoS One Date: 2013-07-18 Impact factor: 3.240
Authors: Daniel Wolff; Vedran Radojcic; Robert Lafyatis; Resat Cinar; Rachel K Rosenstein; Edward W Cowen; Guang-Shing Cheng; Ajay Sheshadri; Anne Bergeron; Kirsten M Williams; Jamie L Todd; Takanori Teshima; Geoffrey D E Cuvelier; Ernst Holler; Shannon R McCurdy; Robert R Jenq; Alan M Hanash; David Jacobsohn; Bianca D Santomasso; Sandeep Jain; Yoko Ogawa; Philipp Steven; Zhonghui Katie Luo; Tina Dietrich-Ntoukas; Daniel Saban; Ervina Bilic; Olaf Penack; Linda M Griffith; Meredith Cowden; Paul J Martin; Hildegard T Greinix; Stefanie Sarantopoulos; Gerard Socie; Bruce R Blazar; Joseph Pidala; Carrie L Kitko; Daniel R Couriel; Corey Cutler; Kirk R Schultz; Steven Z Pavletic; Stephanie J Lee; Sophie Paczesny Journal: Transplant Cell Ther Date: 2021-06-10