title: Diagnosis and treatment of ocular chronic graft-versus-host disease: report from the German-Austrian-Swiss Consensus Conference on Clinical Practice in chronic GVHD.
abstract: OBJECTIVE
  Ocular chronic graft-versus-host disease (cGVHD) is one of the most frequent long-term complications after hematopoietic stem cell transplantation and is often associated with significant morbidity and reduced quality of life.
  
  
  METHODS
  The German/Austrian/Swiss Consensus Conference on Clinical Practice in cGVHD aimed to summarize the currently available evidence for diagnosis and (topical) treatment and to summarize different treatment modalities of ocular cGVHD. The presented consensus was based on a review of published evidence and a survey on the current clinical practice including transplant centers from Germany, Austria, and Switzerland.
  
  
  RESULTS
  Ocular cGVHD often affects the lacrimal glands, the conjunctiva, the lids (including meibomian glands), and the cornea but can also involve other parts of the eye such as the sclera. Up to now, there have been no pathognomonic diagnostic features identified. The main therapeutic aim in the management of ocular cGVHD is the treatment of inflammation and dryness to relieve patients' symptoms and to maintain ocular integrity and function. Therapy should be chosen in the context of the patient's overall condition, systemic immunosuppressive therapy, symptoms, ocular surface integrity, and inflammatory activity. The consensus conference proposed new grading criteria and diagnostic recommendations for general monitoring of patients with graft-versus-host-disease for use in clinical practice.
  
  
  CONCLUSIONS
  The evidence levels for diagnosis and treatment of ocular cGVHD are low, and most of the treatment options are based on empirical knowledge. Topical immunosuppression, for example, with cyclosporine, represents a promising strategy to reduce inflammation and dryness in ocular cGVHD. Further clinical trials are necessary to elucidate risk factors for eye manifestation, complications, and visual loss and to evaluate staging criteria and diagnostic and therapeutic measures for ocular cGVHD.
authors.affiliation: Department of Ophthalmology, University Medical Center, Regensburg, Regensburg, Germany. tina.dietrich@klinik.uni-regensburg.de
authors.forename: Tina
authors.initials: T
authors.lastname: Dietrich-Ntoukas
authors.forename: Claus
authors.initials: C
authors.lastname: Cursiefen
authors.forename: Henrike
authors.initials: H
authors.lastname: Westekemper
authors.forename: Philipp
authors.initials: P
authors.lastname: Eberwein
authors.forename: Thomas
authors.initials: T
authors.lastname: Reinhard
authors.forename: Hartmut
authors.initials: H
authors.lastname: Bertz
authors.forename: Johannes
authors.initials: J
authors.lastname: Nepp
authors.forename: Anita
authors.initials: A
authors.lastname: Lawitschka
authors.forename: Arnd
authors.initials: A
authors.lastname: Heiligenhaus
authors.forename: Berthold
authors.initials: B
authors.lastname: Seitz
authors.forename: Elisabeth M
authors.initials: EM
authors.lastname: Messmer
authors.forename: Tobias
authors.initials: T
authors.lastname: Meyer-ter-Vehn
authors.forename: Nadezda
authors.initials: N
authors.lastname: Basara
authors.forename: Hildegard
authors.initials: H
authors.lastname: Greinix
authors.forename: Manuel B
authors.initials: MB
authors.lastname: Datiles
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Lee
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: Pavletic
authors.forename: Daniel
authors.initials: D
authors.lastname: Wolff
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001317:Austria; D002908:Chronic Disease; D005128:Eye Diseases / Q000175:diagnosis* / Q000188:drug therapy*; D005858:Germany; D006086:Graft vs Host Disease / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D011788:Quality of Life; D013557:Switzerland
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents