title: Ocular surface evaluation in allogenic hematopoietic stem cell transplantation patients.
abstract: OBJECTIVE
  To evaluate ocular surface of chronic graft versus host disease (GVHD) patients in allogeneic hematopoietic stem cell transplantation (allo-HSCT).
  
  
  METHODS
  Cross-sectional study of allo-HSCT patients. Data recorded included Ocular Surface Disease Index (OSDI) score, fluorescein tear break-up time (FTBUT), Schirmer I test, ocular surface staining, dry eye severity, and conjunctival impression cytology (CIC).
  
  
  RESULTS
  Of 40 allo-HSCT patients (mean age 25.7 ± 11.03 years) studied, dry eye disease was noted in 30%. The OSDI was mild in 16.67%, moderate in 45.83%, and severe in 20.83% ocular GVHD (oGVHD) eyes; mild in 94.64%, moderate in 5.36% non-oGVHD eyes (p<0.001). The FTBUT was ≤5 seconds in 45.83%, >5 seconds in 54.17% of eyes with chronic oGVHD. Schirmer I test score was ≤5 mm in 58.33% of eyes with oGVHD. Conjunctival staining score was <3 in 25%, ≥3 in 75% of oGVHD eyes. Corneal staining score of <3 in 79.17%, ≥3 in 20.83% was seen in oGVHD eyes. Chronic oGVHD was seen in 24 eyes, with dry eye severity of level 3 in 17.5%, level 2 in 2.5%, level 1 in 10%. The CIC was abnormal in 75% with altered morphology seen in 22 eyes with oGVHD (91.7%) and 38 eyes without oGVHD (67.9%) (p = 0.024).
  
  
  CONCLUSIONS
  Significant ocular surface changes occur due to chronic oGVHD in allo-HSCT patients. The OSDI score, corneal involvement, and Schirmer I test are indicative of ocular morbidity in post allo-HSCT eyes. Conjunctival impression cytology abnormality is also seen in eyes without oGVHD.
authors.affiliation: Cornea & Ocular Surface Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi - India.
authors.forename: Murugesan
authors.initials: M
authors.lastname: Vanathi
authors.forename: Seema
authors.initials: S
authors.lastname: Kashyap
authors.forename: Rehan
authors.initials: R
authors.lastname: Khan
authors.forename: Tulika
authors.initials: T
authors.lastname: Seth
authors.forename: Pravas
authors.initials: P
authors.lastname: Mishra
authors.forename: Manoranjan
authors.initials: M
authors.lastname: Mahapatra
authors.forename: Radhika
authors.initials: R
authors.lastname: Tandon
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003229:Conjunctival Diseases / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D015352:Dry Eye Syndromes / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D005141:Eyelid Diseases / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D019793:Fluorescein / Q000378:metabolism; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007638:Keratoconjunctivitis Sicca; D008297:Male; D008537:Meibomian Glands / Q000473:pathology*; D008875:Middle Aged; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D019793:Fluorescein