Hideto Ikarashi1, Naohiko Aketa2, Eisuke Shimizu1, Yoji Takano1,3, Tetsuya Kawakita1,4, Yuichi Uchino1, Yukihiro Matsumoto1, Junko Ogawa1,4, Kazuo Tsubota1, Yoko Ogawa1. 1. Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan. 2. Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan. nao.nao.pao.pao@gmail.com. 3. Department of Ophthalmology, Kawasaki Municipal Ida Hospital, Kanagawa, Japan. 4. Department of Ophthalmology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
Abstract
BACKGROUND: Chronic ocular graft-versus-host disease (oGVHD) is an ocular comorbidity of graft-versus-host disease (GVHD) that usually occurs concurrently with systemic manifestations. Failure to detect and treat oGVHD in its early stages may lead to progression of ocular signs and symptoms leading to oGVHD that is refractory to conventional treatment. CASE PRESENTATION: We report the clinical course of a 19-year-old male and a 59-year-old female with severe and progressive chronic oGVHD without concurrent systemic signs of chronic graft-versus-host disease (cGVHD). Although their systemic conditions had been stable, both suffered from severe oGVHD and were referred to our clinic. Both cases exhibited marked improvement in conjunctival inflammation and fibrotic changes after amniotic membrane transplantation (AMT). Both cases underwent keratoplasty eventually to stabilize ocular surface conditions and to improve visual function. CONCLUSIONS: We reported the clinical outcomes of 2 cases of chronic oGVHD without concurrent systemic comorbidities that were treated with AMT. The clinician should be aware that cGVHD may persist in target organs even in the absence of concurrent systemic comorbidities following seemingly successful systemic treatment. A multidisciplinary team approach is essential in the early detection and therapeutic intervention for chronic oGVHD.
BACKGROUND:Chronic ocular graft-versus-host disease (oGVHD) is an ocular comorbidity of graft-versus-host disease (GVHD) that usually occurs concurrently with systemic manifestations. Failure to detect and treat oGVHD in its early stages may lead to progression of ocular signs and symptoms leading to oGVHD that is refractory to conventional treatment. CASE PRESENTATION: We report the clinical course of a 19-year-old male and a 59-year-old female with severe and progressive chronic oGVHD without concurrent systemic signs of chronic graft-versus-host disease (cGVHD). Although their systemic conditions had been stable, both suffered from severe oGVHD and were referred to our clinic. Both cases exhibited marked improvement in conjunctival inflammation and fibrotic changes after amniotic membrane transplantation (AMT). Both cases underwent keratoplasty eventually to stabilize ocular surface conditions and to improve visual function. CONCLUSIONS: We reported the clinical outcomes of 2 cases of chronic oGVHD without concurrent systemic comorbidities that were treated with AMT. The clinician should be aware that cGVHD may persist in target organs even in the absence of concurrent systemic comorbidities following seemingly successful systemic treatment. A multidisciplinary team approach is essential in the early detection and therapeutic intervention for chronic oGVHD.
Authors: Madan H Jagasia; Hildegard T Greinix; Mukta Arora; Kirsten M Williams; Daniel Wolff; Edward W Cowen; Jeanne Palmer; Daniel Weisdorf; Nathaniel S Treister; Guang-Shing Cheng; Holly Kerr; Pamela Stratton; Rafael F Duarte; George B McDonald; Yoshihiro Inamoto; Afonso Vigorito; Sally Arai; Manuel B Datiles; David Jacobsohn; Theo Heller; Carrie L Kitko; Sandra A Mitchell; Paul J Martin; Howard Shulman; Roy S Wu; Corey S Cutler; Georgia B Vogelsang; Stephanie J Lee; Steven Z Pavletic; Mary E D Flowers Journal: Biol Blood Marrow Transplant Date: 2014-12-18 Impact factor: 5.742
Authors: Y Ogawa; S Okamoto; M Wakui; R Watanabe; M Yamada; M Yoshino; M Ono; H Y Yang; Y Mashima; Y Oguchi; Y Ikeda; K Tsubota Journal: Br J Ophthalmol Date: 1999-10 Impact factor: 4.638