Topical Cyclosporine-A in Pediatric Ocular Graft Versus Host Disease
Nilüfer Yalçindağ; Pinar Bingöl Kiziltunç; Tuna Çelik; Mehmet Ertem*; Elif İnce*; Huban Atilla
Ankara University, Faculty of Medicine, Department of Ophthalmology
*Ankara University, Faculty of Medicine, Department of Pediatric Hematology
Introduction: Ocular involvement has been reported with a range between 3-90 % in graft versus host disease (GVHD) and dry eye syndrome is most frequent finding of ocular involvement.Topical cyclosporine-A might be an effective and safe treatment option in dry eye related to chronic GVHD in combination with topical steroids, autologous serum, lubricant eye drops and ointments. In this study we evaluated the efficacy of topical cyclosporine-A in pediatric ocular GVHD patients.
Methods: Pediatric patients with ocular GVHD were enrolled into this study. Ophthalmic examination findings, Schirmer test results, tear break up time and corneal staining grades were recorded. Topical cyclosporine-A treatment was given to the patients with severe dry eye and results were evaluated.
Results: Between 1996-2015, 218 pediatric patients (mean age: 11.8 ± 2.9 years) underwent bone marrow transplantation. GVHD was detected in 51 patients (23.4%) and 30 of them (58.8%) had ocular GVHD. Four patients of ocular GVHD had severe dry eye and were treated with topical cyclosporine-A in addition to topical lubricants with a median follow-up of 12.1 months. Severe dry eye symptoms and findings significantly improved in 2 patients.
Discussion: Tissue damage in GVHD is mediated by activated donor T cells and pharmacological agents such as cyclosporine-A prevents the activation and proliferation of T-cells. Topical cyclosporine-A treatment can be useful in pediatric GVHD patients with ocular involvement.
Conclusion: Ocular involvement is less frequent in pediatric patients and topical cyclosporine-A can improve dry eye symptoms in pediatric ocular GVHD patients.
References: 1- Zecca M. et al. Chronic GVHD in children:incidence, risk factors and impact on outcome. Blood 2002:100;1192-2000
2- Kurt R, Yalçindag N, Atilla H, Arat M. Topical cyclosporin A in dry eye associated with GVHD. Ann Ophthalmol 2009;41:166-9