title: Long-term clinical course of dry eye in patients with chronic graft-versus-host disease referred for eye examination.
abstract: OBJECTIVE
  To assess the long-term clinical course of dry eye in patients with chronic graft-versus-host disease (cGVHD).
  
  
  METHODS
  A prospective case series of 49 patients with cGVHD was conducted. Complete history and ophthalmic examination were performed at baseline and at 36 months (range, 26-53). All patients received treatment for dry eye.
  
  
  RESULTS
  Of the 49 participants, 18 (37%) had expired at the time of the 3-year eye examination, 11 were lost to follow-up, 11 declined or were unable to attend the final examination, and 9 (18%) completed the study. There was a statistically insignificant improvement in symptoms of dry eye assessed by the ocular surface disease index [start vs. endpoint: 36 ± 22 (range, 4-72) vs. 30 ± 27 (range, 4-86); P = 0.51]. Visual acuity remained stable at approximately 20/20. Lissamine green staining improved and Schirmer test (with anesthetic) worsened, but neither trend was statistically or clinically significant.
  
  
  CONCLUSIONS
  Stable visual acuity, tear production, and lissamine green staining and a statistically insignificant improvement in dry eye symptoms were observed in the 9 participants who completed this 3-year prospective case series of 49 patients with cGVHD. Insofar as these patients represent a minority (18%) of the original cohort, their clinical course may not be generalizable to all patients with cGVHD but may still suggest that this patient population's prognosis could be characterized by stability and excellent vision. Sufficiently powered prospective studies are required to validate these postulates.
authors.affiliation: From the Department of Ophthalmology, Division of Blood and Marrow Transplantation, Stanford University Medical Center, Palo Alto, CA, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Sáles
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Johnston
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Ta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004396:Coloring Agents; D003941:Diagnostic Techniques, Ophthalmological; D015352:Dry Eye Syndromes / Q000209:etiology* / Q000503:physiopathology*; D006086:Graft vs Host Disease / Q000209:etiology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008086:Lissamine Green Dyes; D008137:Longitudinal Studies; D008875:Middle Aged; D011446:Prospective Studies; D012017:Referral and Consultation; D013194:Staining and Labeling; D013666:Tears / Q000378:metabolism; D014792:Visual Acuity; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D008086:Lissamine Green Dyes