Use of fluid-ventilated, gas-permeable scleral lens for management of severe keratoconjunctivitis sicca secondary to chronic graft-versus-host disease.
Keratoconjunctivitis sicca (KCS) occurs in 40%-60% of patients with chronic graft-versus-host-disease (cGVHD) after allogeneic hematopoietic cell transplantation. Although immunosuppressive therapy is the primary treatment of chronic GVHD, ocular symptoms require measures to improve ocular lubrication, decrease inflammation, and maintain mucosal integrity. The liquid corneal bandage provided by a fluid-ventilated, gas-permeable scleral lens (SL) has been effective in mitigating symptoms and resurfacing corneal erosions in patients with KCS related to causes other than cGVHD. We report outcomes in 9 consecutive patients referred for SL fitting for cGVHD-related severe KCS that was refractory to standard treatments. All patients reported improvement of ocular symptoms and reduced the use of topical lubricants after SL fitting resulting from decreased evaporation. No serious adverse events or infections attributable to the SL occurred. The median Ocular Surface Disease Index improved from 81 (75-100) to 21 (6-52) within 2 weeks after SL fitting, and was 12 (2-53) at the time of last contact, 1-23 months (median, 8.0) after SL fitting. Disability related to KCS resolved in 7 patients after SL fitting. The use of SL appears to be safe and effective in patients with severe cGVHD-related KCS refractory to conventional therapies.
Takahide
Kikuchi
K
Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA.
Parker
Pablo M
PM
Wu
Michael
M
Hwang
William Y K
WY
Carpenter
Paul A
PA
Moravec
Carina
C
Stehr
Barbara
B
Martin
Paul J
PJ
Rosenthal
Perry
P
Forman
Stephen J
SJ
Flowers
Mary E D
ME
D000328:Adult; D001458:Bandages; D002908:Chronic Disease; D003262:Contact Lenses, Extended-Wear; D019468:Disease Management; D005135:Eye Protective Devices; D006086:Graft vs Host Disease / Q000150:complications*; D006801:Humans; D007638:Keratoconjunctivitis Sicca / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D012189:Retrospective Studies; D016879:Salvage Therapy; D012590:Sclera; D016896:Treatment Outcome
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