Keratoconjunctivitis Sicca Due To Chronic Graft Versus Host Disease:Case Report

Aims:We through the well understand of pathogenesis,clinical features,severity and grading,progression of chronic graft-versus-host disease(cGVHD)related dry eye,to provide a comprehensive and effective treatment for the disease.Methods:We discus 2 typical cGVHD related dry eye cases by follow-up with Ocular surface disease index(QSDI)questionnaire,routine ophthalmic examination and combined with ocular surface analyzer,so that we refine the severity and grading of disease,and also evaluate the efficacy of treatment in the long-term follow-up.Results:For Case 1,patient undergo a full consistency-unrelated bone marrow transplantation after 3 years and more,and at the same time diagnosed as bilateral cGVHD related dry eye.QSDI 25 points(moderate),define as cGVHD score 8(moderate)by ocular surface analyzer and routine ophthalmic examination.Bilateral ocular score 6(moderate),QSDI<13(normal)after strengthen the typical anti-immune treatment.For case 2,patient undergo haplo-related bone marrow transplantation after 2 years and more,at the same time diagnosed as bilateral dry eye disease and without eye GVHD assessments,half more year later patient diagnosed as bilateral cGVHD related dry eye,QSDI 79.17 points(severe),define as cGVHD 9 points(severe)by ocular surface analyzer and routine ophthalmic examination,and slight improvement after strengthen typical anti-immune treatment.Conclusion:Ocular cGVHD is common after transplantation,it is often overlooked because of the grave manifestations of systemic involvement and the numerous discrepancies in definitions.In clinical we use OSDI questionnaire,routine ophthalmic examination combined with ocular surface analyzer to provide a more accurate assessment for the ocular cGVHD classification and grading,thus to attain effectively management and comprehensive treatment for ocular cGVHD patients.