title: Bilateral corneal ulceration in ocular graft-versus-host disease.
abstract: OBJECTIVE
  To report on corneal ulceration in ocular graft-versus-host disease (GVHD).
  
  
  METHODS
  This was a retrospective, observational case series investigating corneal ulceration and perforation in a cohort of ocular GVHD patients seen between June 2007 and October 2012.
  
  
  RESULTS
  Four of 243 ocular GVHD patients developed corneal ulcerations attributable to ocular GVHD, and all four cases involved bilateral corneal ulceration. The median length of time from the diagnosis of ocular GVHD to the diagnosis of the first corneal ulceration was 317 days (range 168-434). The median length of time between the diagnosis of corneal ulceration in each patient's first and second eye was 248 days (range 9-645). Outcomes varied from complete resolution with medical treatment to corneal perforation necessitating penetrating keratoplasty. In cases of corneal perforation, the median length of time from the diagnosis of corneal ulceration to perforation was 10 days (range 0-20). Common clinical features included: centrally or paracentrally located ulcerations and perforations, concomitant dry eye, and the use of topical or systemic corticosteroids.
  
  
  CONCLUSIONS
  Frequent follow-up and bilateral monitoring are highly recommended in cases of ocular GVHD-associated stromal thinning, as bilateral involvement or rapid progression to corneal perforation can occur.
authors.affiliation: Cornea Service, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
authors.forename: William
authors.initials: W
authors.lastname: Stevenson
authors.forename: Hasanain
authors.initials: H
authors.lastname: Shikari
authors.forename: Ujwala S
authors.initials: US
authors.lastname: Saboo
authors.forename: Francisco
authors.initials: F
authors.lastname: Amparo
authors.forename: Reza
authors.initials: R
authors.lastname: Dana
keywords: corneal perforation; corneal ulceration; graft-versus-host disease; ocular graft-versus-host disease