The use of topical cyclosporin A in ocular graft-versus-host-disease

Abstract

Summary:Ocular manifestations of GVHD include keratoconjunctivitis sicca, cicatricial lagophthalmos, sterile conjunctivitis, persistent corneal epithelial defects, corneal ulcers and corneal melting. Conventional initial therapy such as lubrication and topical steroids is directed to treat decreased tear production and ocular surface abnormalities. The purpose of this study was to illustrate the possible benefit of topical cyclosporin A 1% (CsA) as an adjunct in managing ocular surface abnormalities in five cases of GVHD refractory to conventional therapy. Five clinical case reports of chronic GVHD patients in whom conventional therapy was inadequate to stop the progression from its initial presentation are described. Patient presentation varied in severity on a spectrum of mild to moderate diffuse punctate epithelial erosions to sterile necrotizing corneal melts. Although systemic therapy for GVHD consisting of systemic immunosuppressants (ie cyclosporin A and corticosteroids) was given to these patients, this therapy was insufficient in managing the ocular manifestations of the disease. Topical CsA was added to the treatment regimen and the progression of the ocular disease was recorded. The addition of topical CsA 1% probably helped in controlling the epithelial keratitis and melting process in our reported cases and we conclude that topical CsA may be an appropriate modality in managing ocular surface abnormalities in patients with ocular GVHD after conventional treatments have been tried. However, a further randomized clinical prospective study is needed to evaluate the efficacy of topical CsA in managing these problems in GVHD patients.

Therapeutic effect of umbilical cord serum eyedrops for the treatment of dry eye associated with graft-versus-host disease

“…1 Dry eye associated with GVHD is known to be difficult to treat with conventional treatment including the instillation of artificial tears. 3,9 Murphy et al 4 reported a patient who responded to 0.05% topical retinoic acid with reversal of conjunctival keratinization and resolution of symptoms. Ogawa et al 5 treated dry eye successfully in two patients with chronic GVHD with systemic administration of FK506 and corticosteroids, and Kiang et al 6 used topical cyclosporine A in five patients to control the epithelial keratitis and melting process.…”

“…[1][2][3] Dry eye associated with GVHD is known to be difficult to treat with conventional treatment including the application of artificial tears, therapeutic contact lenses, protective goggles or anterior chamber glasses, punctal occlusion, topical retinoic acid, topical or systemic corticosteroids, and immunosuppressive agents such as cyclosporin A and FK 506. [1][2][3][4][5][6] Autologous serum contains substances like epidermal growth factor (EGF), vitamin A, transforming growth factor-b (TGF-b), fibronectin, and other cytokines that are essential for the maintenance of the corneal and conjunctival epithelia and has been used effectively to treat severe dry eye in patients with chronic GVHD. [7][8][9] Recently, we found that umbilical cord serum also contains many growth factors and essential tear components, and umbilical cord serum eyedrops are safe and effective for treating dry eye syndrome and persistent epithelial defect.…”

Corneal grafting and aggressive medication for corneal defects in graft-versus-host disease following bone marrow transplantation

“…15 The more severe ocular complications are associated with severe systemic cGVHD and poorer survival. 2,3 All patients enroled in this study had systemic signs of cGVHD at the time of admission. Two male patients, aged 18 and 51 years, died after 8 and 46 months of follow-up (due to heart attack and arterial embolism, respectively).…”

“…Ocular involvement is very common in patients with cGVHD and includes keratoconjunctivitis sicca, cicatrical lagophthalmos, persistent corneal epithelial defect (PED), corneal ulcers, and corneal melting that could lead to perforation and quickly developing endophthalmitis. [2][3][4][5][6] The majority (60-100%) of these patients show evidence of dry eye syndrome, therefore late complications are often severe and rarely amenable to pharmacologic or surgical treatment.…”

Topical corticosteroid therapy for cicatricial conjunctivitis associated with chronic graft-versus-host disease

“…7,8,13,14 Systemic immunosuppressive therapy can be used to treat ocular GVHD; 5,[15][16][17] however, some patients with cicatricial conjunctivitis progress despite systemic treatment. 18 Herein, we reviewed our results using topical ocular corticosteroids for progressive cicatricial conjunctivitis from GVHD.…”