Treatment of ocular graft-versus-host disease with topical cyclosporine 0.05%.
OBJECTIVE
To evaluate the efficacy of topical cyclosporine-A 0.05% (CsA) in the treatment of dry eye syndrome in ocular graft-versus-host disease after bone marrow transplantation (BMT) of hematopoietic stem cells.


METHODS
One-hundred five patients were enrolled in a retrospective, comparative, interventional case series. Eighty-one patients received topical CsA starting 1 month before BMT (treatment group), and 24 patients did not receive CsA until at least 6 months after the transplantation (control group). Mean follow-up time was 17.5 ± 11.0 months (range: 6.0-49.0 months). Clinical history, ocular surface disease index questionnaire, slit-lamp examination, lissamine green and fluorescein staining of the ocular surface, tear breakup time, and Schirmer test with topical anesthesia were obtained to create a composite dry eye-grading score.


RESULTS
Dry eye symptoms were significantly more severe in the control group at 3 months, 1 year, and 2 years (P < 0.05). There was no correlation with type of stem cell transplant (related vs. unrelated donor), presenting indication for BMT, or concurrent systemic immunosuppressive medications.


CONCLUSIONS
Pre-BMT initiation of topical CsA may reduce the inflammatory response in the lacrimal glands that may be responsible for the development of post-BMT keratitis sicca.
Malta
João Baptista
JB
Department of Ophthalmology and Visual Sciences, WK Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI 48105, USA.
Soong
H Kaz
HK
Shtein
Roni M
RM
Musch
David C
DC
Rhoades
William
W
Sugar
Alan
A
Mian
Shahzad I
SI
D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000008:administration & dosage*; D015352:Dry Eye Syndromes / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D005260:Female; D019793:Fluorescein; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008086:Lissamine Green Dyes; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013666:Tears / Q000737:chemistry / Q000378:metabolism; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D008086:Lissamine Green Dyes; D016572:Cyclosporine; D019793:Fluorescein