Ocular Surface Risk Factors for Ocular GVHD

By Patrick Daly - Last Updated: December 22, 2022

In Frontiers in Oncology, researchers described ocular surface characteristics and risk factors of ocular graft-versus-host disease (oGVHD), a notable complication of allogeneic hematopoietic stem cell transplantation (HSCT) that impacts quality of life and prognosis.

They noted oGVHD typically developed after GVHD in other organs, with few exceptions, and severe corneal epitheliopathy was associated with more severe oGVHD lid margin lesions. Furthermore, researchers found patients who received a partially matched human leukocyte antigen (HLA) graft had less severe corneal epithelium and lid margin lesions.

Ocular Surface Lesion Severity Correlated With Corneal Epitheliopathy

This retrospective study reviewed the right eye of 248 patients who underwent HSCT; developed ocular symptoms, including dry eyes, photophobia, and foreign body sensation; and were subsequently diagnosed with oGVHD.                Investigators assessed gender, age, primary disease, donor source, HLA type, kinship, donor relationship, blood type, systemic GVHD, and graft source for associations with ocular surface lesion grades.

Using scoring methods suggested in published records, the cohort had a median score of 3 out of 6 for corneal epitheliopathy, 6 out of 14 for lid margin lesions, and 2 out of 6 for meibomian gland, the authors reported.

Authors noted corneal epitheliopathy grade was related to donor source (P<.001), kinship (P=.033), HLA-matching (P<.001), and systemic GVHD (P=.007), particularly oral GVHD (P<.001) and liver GVHD (P=.002).

In addition, lid margin lesion score was associated with donor source (P=.019), HLA-matching (P=.006), and systemic GVHD (P=.013), especially skin GVHD (P=.019) and oral GVHD (P=.019). Meibomian gland loss was related to age (P=.035) and gastrointestinal GVHD (P=.007). Finally, grade of corneal epitheliopathy after HSCT was associated with lid margin lesion grade (P<.001).

“The occurrence and development of ocular GVHD are mostly accompanied by the history of systemic GVHD,” the authors summarized. In closing, they highlighted the varying effects on the ocular surface and oGVHD observed with different patient and HSCT characteristics.

Read More: Fecal Microbiome Markers Predict GVHD Outcomes