Long Term Outcomes of Ocular Graft-Versus-Host Disease -5289
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Author’s Disclosure Block: Karanvir Gill, none; Barbara Burgos-Blasco, none; Alfonso Iovieno, none; Sonia N. Yeung, none
Abstract Body
Purpose:This study investigated long-term clinical outcomes in patients with chronic ocular graft-versus-host disease (oGVHD). Study Design: Retrospective cohort study on patients diagnosed with oGVHD who had at least one year of follow-up. Patient charts from a Vancouver-based clinic were reviewed for cases between June 2012, and May 2024. Methods: This retrospective cohort study examined patients diagnosed with oGVHD. Patient data were obtained through a comprehensive chart review, including demographics, clinical features, and prior treatments. We assessed slit-lamp exam findings, treatments, and complicationsover a five-year period, following their initial visit. Descriptive statistics, including means, standard deviations, and frequencies, were used to characterize patient demographics, prevalence of ocular surface disease, and treatment modalities. Longitudinal trends in disease progression and treatment responses were analyzed to evaluate the evolution of oGVHD-related ocular conditions. Data were stratified by key clinical features to identify changes in ocular surface parameters over time. Results: The cohort consisted of 189 patients with a mean age of 48.0 years (SD 13.4)at the time of stem cell or bone marrow transplant. The mean follow-up period was 51.4 months (SD 35.6). At baseline, 81.5% of patients had meibomian gland dysfunction (MGD), 49.7% had superficial punctate keratitis, and 11.6% had conjunctival hyperemia. Previous dry eye treatments were common, with 69.8% having received topical treatments, 63.0% artificial tears, and 5.3% topical steroids. During follow-up at year 5, 92.1% of patients continued to use artificial tears, 20.6% were treated with topical steroids, 7.4% with cyclosporine, and 47.1% with autologous serum. Punctal cautery was used in 28.0% of cases, while scleral contact lenses were required in 19.0%. Only 0.5% received treatment with amniotic membrane. Over the years, the prevalence of MGD remained high (56.1% by year 5), while superficial punctate keratitis persisted in 55.6% by year 5. Filamentary keratitis, corneal neovascularization, and limbal stem cell deficiency (LSCD) were observed in 3.7%, 2.6%, and 4.8% of patients, respectively, by year 5. Conclusion: Patients with chronic oGVHD experience persistent ocular surface disease despite extensive treatment strategies. Artificial tears and topical steroids were the most common treatments, but additional options such as punctal cautery, scleral lenses, and autologous serum became necessary over time. The high prevalence of meibomian gland dysfunction and superficial punctate keratitis suggests a chronic, progressive course requiring long-term management. This study highlights the importance of individualized treatment approaches and the need for further research into more effective therapies to manage the ocular complications associated with oGVHD.