Corneal grafting and aggressive medication for corneal defects in graft-versus-host disease following bone marrow transplantation.
OBJECTIVE
To evaluate the clinical outcomes of corneal grafting for severe dry eye complications in bone marrow transplant recipients.


METHODS
Eleven eyes of nine patients with severe corneal complications of chronic graft-versus-host disease were treated from 2000 to 2005. The subjects underwent penetrating keratoplasty (n=9 eyes; seven for perforation and two for leucoma) or deep anterior lamellar keratoplasty (n=2 eyes) for deep postinflammatory stromal scarring without endothelial abnormalities. Patients were observed for graft survival, visual acuity, and postoperative complications.


RESULTS
During the follow-up period (mean=21.6 months), nine grafts (82%) remained clear or almost entirely clear and gained more than two logarithmic units of best-corrected visual acuity. Two regrafts were necessary as the primary grafts became cloudy after 9 and 11 months. Persistent epithelial defects occurred in seven eyes (64%), cataract in six (55%), ocular hypertension in five (45%), corneal calcareous degeneration in two (18%), loss of clarity in two (18%), and sterile ulceration in one (9%).


CONCLUSIONS
Corneal grafting was effective for restoring corneal clarity and improving visual function in this series of patients. Although the complication ratio was high and some patients required regrafting, there was a clinical improvement in the majority of patients.
Tarnawska
D
D
Department of Ophthalmology, District Railway Hospital, Katowice, Poland. dorota.tarnawska@interia.pl
Wylegała
E
E
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D016039:Corneal Transplantation / Q000009:adverse effects / Q000379:methods*; D004334:Drug Administration Schedule; D015352:Dry Eye Syndromes / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D015948:Keratoplasty, Penetrating / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D012086:Reoperation; D013666:Tears / Q000378:metabolism; D016896:Treatment Outcome; D014792:Visual Acuity
D007166:Immunosuppressive Agents