Extended Soft Bandage Contact Lens Therapy and Optical Coherence Tomography Evaluation for Ocular Graft-Versus-Host Disease
Purpose
Graft-versus-Host Disease (GVHD) is a major complication of allogenic hematopoietic cell transplantation. 60% of GVHD patients have ocular involvement with significant compromise in quality of life due to ocular symptoms (such as severe photophobia, pain and decreased visual acuity). We report the structural changes on anterior segment optical coherence tomography (AS-OCT) and the outcome of extended soft bandage contact lens (BCL) treatment for symptomatic relief and ocular surface protection in ocular GVHD patients.
Methods
This was a Phase II clinical trial. IRB approval of the clinical protocol was first obtained, and all patients signed informed consent. Patients (age 18-99) with the diagnosis of chronic GVHD as defined by the NIH criteria and ocular symptoms of NIH eye score 2 or greater were eligible. Extended soft bandage contact lenses were applied to the GVHD-affected eyes with antibiotic coverage. Ocular exam, AS-OCT and patient survey were performed. Patients were followed for three months. Clinical outcomes, such as visual acuity, corneal presentations (abrasion, punctate epithelial erosion and filament) are correlated with symptomatic survey findings as well as AS-OCT findings.
Results
Nineteen patients with ocular GVHD were included in the study. Ocular manifestations of GVHD observed by clinical exam were correlated with AS-OCT which was performed on 14 out of 19 patients. According to ophthalmologic examination at 2 weeks, ocular GVHD showed 89% improvement, 5% stability and 5% worsening. According to the Lee eye subscale, 44% showed clinically meaningful improvement at 2 weeks and 53% at 4 weeks. AS-OCT is promising in visualizing several ocular GVHD manifestations, such as abnormal meibomian gland orifice, conjunctival hyperemia, corneal epithelium opacification, thinning and sloughing. Patient’s visual acuity after BCL therapy was well correlated with AS-OCT findings (P<0.05).
Conclusion
BCL therapy offers significant symptomatic relief for patients with ocular GVHD. Wearing of extended soft bandage contact lens can diminish the irritation of cornea from eyelid and provide improved vision for patients with ocular GVHD. AS-OCT can be a feasible method to characterize the dynamic ocular surface changes related to ocular GVHD.