Ocular manifestations of chronic graft-versus-host disease in patients treated with extracorporeal photochemotherapy.
OBJECTIVE
Eye involvement has long been appreciated in patients with chronic graft versus host disease (cGVHD). In particular, ocular complications are frequent and can be potentially severe in patients with steroid-refractory cGVHD, and therefore necessitate close monitoring. This prospective study was designed to describe eye manifestations of cGVHD in a large series of patients monitoring them before and after 1 year of extracorporeal photochemotherapy (ECP). ECP is a relatively new therapeutic approach based on the biological effects of psoralen 8-methoxypsoralen (8-MOP) and ultraviolet A light (UVA) on mononuclear cells collected by apheresis, and reinfused into the patient.


METHODS
Only patients with steroid-refractory cGVHD under treatment with ECP, who developed cGVHD-related eye symptoms, were selected for the study. Ophthalmologic examination was repeated every 3 months. Only patients with complete recovery of the ocular manifestations and symptoms were considered responsive.


RESULTS
In our study we observed eye alterations in 24 out of 140 patients (17%) with cGVHD. After 12 months of ECP, 10 out of 21 patients (48%) completely responded to the therapy. In all these cases the contribution of ECP was also essential in all the other organs subject to cGVHD.


CONCLUSIONS
Further studies are necessary to clarify the role of ECP in patients with cGVHD, especially in associated eye manifestations. Although our experience is limited, it suggests that ECP could be a safe and effective therapy for steroid-refractory eye manifestations of cGVHD.
Motolese
E
E
Department of Ophthalmology and Neurosurgery, University of Siena, Siena, Italy. motolese@unisi.it
Rubegni
P
P
Poggiali
S
S
Motolese
P A
PA
Marotta
G
G
Russo
L
L
D'Ascenzo
G
G
Carcagni
M R
MR
Fruschelli
M
M
Motolese
I
I
Fimiani
M
M
D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D005128:Eye Diseases / Q000209:etiology / Q000628:therapy*; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000628:therapy*; D006402:Hematologic Diseases / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008730:Methoxsalen / Q000627:therapeutic use; D008875:Middle Aged; D017893:Photopheresis / Q000379:methods*; D011446:Prospective Studies; D014184:Transplantation, Homologous; D014466:Ultraviolet Rays
D008730:Methoxsalen