Paracentral Corneal Melting in 4 Patients With Chronic Graft-Versus-Host Disease
Narrative Responses:
Purpose
To identify the symptomatology and clinical course of patients with chronic graft-versus-host disease (GVHD) who developed sterile corneal melting.
Methods
Retrospective case series looking at 4 patients who received allogenic bone marrow transplants and developed chronic ocular GVHD associated with sterile corneal melting. The timing of melt, ocular findings, treatments, and vision outcomes are shown.
Results
In this series, time of onset from bone marrow transplant to time of ulceration ranged from 16 months to 23 years. Three of 4 patients demonstrated signs of systemic GVHD at the time of ulceration, while one patient only had ocular findings. All patients were treated for keratoconjunctivitis sicca with lubrication including autologous serum drops, preservative free artificial tears, and punctal occlusion. Two cases involved partial melts, while the remaining two had complete melts resulting in corneal perforation. One patient required penetrating keratoplasty twice to address recurrent perforation. Vision at follow-up ranged from 20/20 to 2’/200.
Conclusion
Sterile corneal melting is a vision threatening complication of GVHD that can vary both in severity and response to treatment.