Bilateral corneal ulceration in ocular graft-versus-host disease

William Stevenson, Hasanain Shikari, Ujwala S Saboo, Francisco Amparo, Reza Dana

Cornea Service, Massachusetts Eye and Ear Infirmary, Boston, MA, USA

Purpose: To report on corneal ulceration in ocular graft-versus-host disease (GVHD).
Methods: This was a retrospective, observational case series investigating corneal ulceration and perforation in a cohort of ocular GVHD patients seen between June 2007 and October 2012.
Results: Four of 243 ocular GVHD patients developed corneal ulcerations attributable to ocular GVHD, and all four cases involved bilateral corneal ulceration. The median length of time from the diagnosis of ocular GVHD to the diagnosis of the first corneal ulceration was 317 days (range 168–434). The median length of time between the diagnosis of corneal ulceration in each patient's first and second eye was 248 days (range 9–645). Outcomes varied from complete resolution with medical treatment to corneal perforation necessitating penetrating keratoplasty. In cases of corneal perforation, the median length of time from the diagnosis of corneal ulceration to perforation was 10 days (range 0–20). Common clinical features included: centrally or paracentrally located ulcerations and perforations, concomitant dry eye, and the use of topical or systemic corticosteroids.
Conclusion: Frequent follow-up and bilateral monitoring are highly recommended in cases of ocular GVHD-associated stromal thinning, as bilateral involvement or rapid progression to corneal perforation can occur.

Keywords: graft-versus-host disease, ocular graft-versus-host disease, corneal ulceration, corneal perforation