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Graft versus host disease: clinical evaluation, diagnosis and management

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Abstract

Graft versus H\host disease (GVHD) can be a devastating complication following bone marrow transplantation. Acute or chronic systemic GVHD can be lethal, and severe damage of different organs and tissues can occur with both types of GVHD. Ocular involvement, either in an acute or chronic presentation, may range from mild to severe with accompanying vision loss present in 60–90 % of patients. Chronic ocular GVHD, the most common form of GVHD, affects mainly the lacrimal gland, meibomian glands, cornea and conjunctiva, mimicking other immunologically mediated inflammatory diseases of the ocular surface without specific symptoms or signs. However, dry eye disease is the main manifestation of GVHD. The long-term treatment of ocular GVHD continues to be challenging and involves a multidisciplinary approach wherein the ophthalmologist plays a major role. Besides systemic immunosuppression and ocular lubricants, topical steroids and topical cyclosporine are commonly prescribed. Newer therapeutic interventions for moderate and severe ocular GVHD include the use of serum eye drops and scleral contact lenses. In this manuscript, we review the mechanisms, clinical findings, and treatment of ocular GVHD.

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Authors and Affiliations

  1. Department of Cornea, External Disease and Refractive Surgery, Department of Ophthalmology, University of South Florida, Tampa, FL, USA

    Edgar M. Espana & Sejal Shah

  2. Department of Cornea, External Disease and Refractive Surgery, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA

    Marcony R. Santhiago

  3. Department of Ophthalmic Oncology, The Cole Eye Institute, Cleveland, OH, USA

    Arun D. Singh

  4. The Cole Eye Institute and Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, 44195, USA

    Arun D. Singh

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  1. Edgar M. Espana
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  2. Sejal Shah
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  4. Arun D. Singh
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Correspondence to Arun D. Singh.

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Espana, E.M., Shah, S., Santhiago, M.R. et al. Graft versus host disease: clinical evaluation, diagnosis and management. Graefes Arch Clin Exp Ophthalmol 251, 1257–1266 (2013). https://doi.org/10.1007/s00417-013-2301-z

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  • DOI: https://doi.org/10.1007/s00417-013-2301-z

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