Current treatment of ocular GVHD (oGVHD), represented by systemic immunosuppressive regimens and local therapies (mainly artificial tears and corticosteroids), gives unsatisfactory results. We investigated the safety and efficacy of autologous plasma rich in PDGFs to treat oGVHD unresponsive to standard medications. A total of 23 patients with refractory oGVHD (grade II-IV) unresponsive to standard therapy were treated with autologous plasma rich in PDGFs eye drops (PRGD) four times/day for 6 months. Symptoms and signs (best visual acuity, Schirmer's test and tear break up time (TBUT), evaluation of the anterior segment and fluorescein and lissamine staining) were always assessed by the same ophthalmologist. Patients were defined as 'responders' when showing improvement for total complaints and at least one sign. At 30 days of treatment, 17 patients (73.9%) were classified as responders. The symptom that improved most was photophobia (improved in 19 patients, 82.6%). TBUT improved in 20 patients (86.9%) and anterior segment score in 19 patients (82.6%). Response was maintained over time. No serious adverse events occurred. PRGD proved to be safe and effective in treating oGVHD and may be a valid treatment option from the early stages of the disease to avoid irreversible ocular damage.
Current ocular GvHD (oGvHD) treatments are suboptimal. We investigated the safety and efficacy of long-term continuous treatment with autologous platelet lysate (PL) drops in patients with oGvHD Dry Eye Syndrome (DES) score 2-3 refractory to topical conventional therapy. Ophthalmic evaluation was performed at 6 month intervals. Symptoms were assessed using the Glaucoma Symptom Scale (GSS). Patients were defined 'responders' when showing a reduction at least one grade on National Institutes of Health Eye Score from baseline at the 6 month visit. Thirty-one patients were included, and 16 (51%) completed 36 months of follow-up (range 6.5-72.7). At 6 months all patients were classified as responders: median GSS symptom score decreased from 70 to 41 (33 at 36 months), median GSS function score reduced from 68 to 46 (33 at 36 months) (all P<0.001). Median Tear Break Up Time improved from 3 to 6 s after 6 months and was maintained over time. All signs improved at 6 and 36 months (clinical and statistical significance). No severe adverse events occurred. Long-term treatment with PL drops is secure and effective for oGvHD and can be an efficient therapy option from initial stages of oGvHD to prevent permanent ocular impairment and improving quality of life.
This study confirms previous reports of increased anterior chamber volume and angle after LPI and Pentacam is a good objective instrument to demonstrate the efficacy of LPI.
The study pointed out a high power of Pentacam AVA, ACV, and ACD in detecting occludable angles. Pentacam is simple to use, reliable, and noncontact, provides parameters in a short period, and represents a possible screening tool.
Ocular GvHD affects about 40-60% of patients receiving bone marrow transplantation. Ocular complaints worsen quality of life (QoL), which, besides survival time, is a primary end point in a patient's follow-up. The aim of our study was to assess the ocular surface status and vision-related QoL (VRQoL) and explore the potential determinants in VRQoL in patients with chronic GvHD with ocular involvement. In this cross-sectional study, we investigated 40 patients with ocular GvHD after allogeneic hematopoietic stem cell transplantation assessing ocular symptoms and signs, VRQoL and ophthalmologic parameters. The median age was 52.1 years; 32.5% were females. Most of them presented a multiple organ involvement. Ophthalmological parameter examinations were on average abnormal. Corneal staining was severe/very severe in 25%; conjunctival staining in 10% of subjects. The worse QoL scores were on 'general vision', 'ocular pain', 'vision-specific mental health' and 'vision-specific role difficulties'. Both symptoms and sign scores indicate poor VRQoL. A lower VRQoL was related to schooling level, job position, underlying disease and extracorporeal photopheresis. Corneal staining, Schirmer and tear film breakup time were negatively associated to visual function-related subscales. An accurate ophthalmological and VRQoL assessment should be mandatory for a long time to promptly recognize early signs of ocular suffering, and to prevent irreversible ocular complications.
Purpose To analyze improvement of visual acuity(VA) and visual evoked patterned potentials (pVEP) in children diagnosed by MR as cerebral visual impaired (CVI) after rehabilitation (refractive correction and occlusion terapy).
Methods In 45 CVI infants(mean age 5.6)we analysed VA and pVEPs improvement after 1 year of follow up. Teller Acuity Cards and/or optotype were used for decimal visual acuity. P‐VEPs were recorded at Oz,O1,O2, referenced to Fz. At least two spatial frequencies (among 300’,120’,60’,30’,15’).Statistical analysis were made between VA and pVEP improvement.
Results VEP and VA percentage of success was 100% and 89% respectively at the beginning; after 1 year VA percentage of success rised 100%. Mean VA before treatment was 2,29/10(0.2‐10); after treatment was 3,61/10(0.1‐10). VA improvement was statistically significant(z=0,00) VA improvement occurred in 68,89%, while 31,11% were unimproved. Improved VEP were 80% and unimproved 20%. We considered improved VEP when children were able to detect lower spatial frequencies or when, in the same spatial frequency, we found higher amplitudes and reduced latencies. Differences between VEP amplitude and latency were not statistically significant in all frequencies but in L60’ (T‐test L60':0.02). There was an association between VA improvement and therapy,(Pr = 0.02) There wasn’t association (Pr = 0.76) between VEP improvement and therapy. There wasn’t correlation between VA and VEP improvement.
Conclusion We found an improvement both in VA and VEP.VEP improvement is independent of therapy,VA improvement is correlated with therapy.
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