Treatment of ocular graft-versus-host disease with topical cyclosporine 0.05%

Cornea. 2010 Dec;29(12):1392-6. doi: 10.1097/ICO.0b013e3181e456f0.

Abstract

Purpose: To evaluate the efficacy of topical cyclosporine-A 0.05% (CsA) in the treatment of dry eye syndrome in ocular graft-versus-host disease after bone marrow transplantation (BMT) of hematopoietic stem cells.

Methods: One-hundred five patients were enrolled in a retrospective, comparative, interventional case series. Eighty-one patients received topical CsA starting 1 month before BMT (treatment group), and 24 patients did not receive CsA until at least 6 months after the transplantation (control group). Mean follow-up time was 17.5 ± 11.0 months (range: 6.0-49.0 months). Clinical history, ocular surface disease index questionnaire, slit-lamp examination, lissamine green and fluorescein staining of the ocular surface, tear breakup time, and Schirmer test with topical anesthesia were obtained to create a composite dry eye-grading score.

Results: Dry eye symptoms were significantly more severe in the control group at 3 months, 1 year, and 2 years (P < 0.05). There was no correlation with type of stem cell transplant (related vs. unrelated donor), presenting indication for BMT, or concurrent systemic immunosuppressive medications.

Conclusions: Pre-BMT initiation of topical CsA may reduce the inflammatory response in the lacrimal glands that may be responsible for the development of post-BMT keratitis sicca.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Topical
  • Adolescent
  • Adult
  • Aged
  • Bone Marrow Transplantation
  • Child
  • Child, Preschool
  • Cyclosporine / administration & dosage*
  • Dry Eye Syndromes / drug therapy*
  • Dry Eye Syndromes / etiology
  • Dry Eye Syndromes / metabolism
  • Female
  • Fluorescein
  • Follow-Up Studies
  • Graft vs Host Disease / drug therapy*
  • Graft vs Host Disease / etiology
  • Graft vs Host Disease / metabolism
  • Hematopoietic Stem Cell Transplantation / adverse effects
  • Humans
  • Immunosuppressive Agents / administration & dosage*
  • Lissamine Green Dyes
  • Male
  • Middle Aged
  • Neoplasms / therapy
  • Retrospective Studies
  • Surveys and Questionnaires
  • Tears / chemistry
  • Tears / metabolism
  • Treatment Outcome

Substances

  • Immunosuppressive Agents
  • Lissamine Green Dyes
  • Cyclosporine
  • Fluorescein