European Journal of Cardiovascular Medicine

Chronic Graft-Versus-Host Disease (cGVHD) is a major long-term complication of allogeneic hematopoietic stem cell transplantation (HSCT), with ocular involvement being one of the most common manifestations. Ocular Surface Disease (OSD) in cGVHD patients leads to dry eye symptoms, discomfort, and potential vision impairment. The underlying pathology is believed to be linked to immune-mediated damage to the lacrimal and meibomian glands, resulting in tear film instability and ocular surface inflammation.

The assessment of OSD in cGVHD patients is critical for prompt management and improved quality of life. This study aims to comprehensively evaluate ocular surface parameters using standardized tests and identify correlations with disease severity.

Study Design and Population

This cross-sectional study included 120 patients diagnosed with cGVHD post-allogeneic HSCT, aged between 18 and 65 years. Patients were recruited from tertiary care centers specializing in post-transplant care.

Inclusion Criteria:

• Confirmed diagnosis of cGVHD
• Age >18 years
• No history of prior ocular surgery or pre-existing ocular surface disease unrelated to cGVHD

Exclusion Criteria:

• Ocular infections or allergies
• Use of systemic immunosuppressive therapy for non-cGVHD conditions

Assessment Tools

1. Schirmer's Test (without anesthesia): Measures basal and reflex tear production.
2. Ocular Surface Disease Index (OSDI): Subjective assessment of ocular discomfort and impact on daily life.
3. Oxford Staining Score: Evaluates corneal and conjunctival staining to assess epithelial damage.
4. Meibomian Gland Assessment: Evaluates gland functionality and dropout.

Statistical Analysis

Data were analyzed using SPSS Version 25. Correlations between ocular surface parameters and cGVHD severity were determined using Pearson’s correlation coefficient, with significance set at p < 0.05.

Table 1: Demographics and Clinical Characteristics of Study Participants

Table 2: Ocular Surface Evaluation

The findings of this study demonstrate that OSD is highly prevalent in patients with cGVHD, with the majority exhibiting significant tear production deficiencies and meibomian gland dysfunction. The results align with previous studies indicating ocular surface involvement as a primary feature of cGVHD. Schirmer's test and OSDI scores were effective in identifying patients at risk of severe ocular discomfort.

Meibomian gland dysfunction, observed in more than half of the patients, further contributes to tear film instability, exacerbating dry eye symptoms. The correlation between Oxford Staining Scores and cGVHD severity underscores the importance of epithelial integrity assessment in clinical evaluations.

Additionally, the findings support the necessity of a multi-modal approach to diagnose and manage ocular complications in cGVHD patients. Routine screenings and early intervention may prevent progressive damage and improve patient quality of life.

The findings of this study demonstrate that OSD is highly prevalent in patients with cGVHD, with significant tear production deficiencies and meibomian gland dysfunction observed in the majority of patients. Ogawa et al. [1] identified cGVHD as a primary cause of severe dry eye in transplant recipients, highlighting the critical role of immune-mediated damage in ocular surface instability. Inamoto et al. [2] validated the effectiveness of Schirmer's Test and OSDI as reliable indicators for assessing OSD severity, which aligns with our findings of 68% of patients displaying abnormal Schirmer's Test results and 80% with elevated OSDI scores. Meibomian gland dysfunction, which was observed in 58% of patients in this study, correlates with the work of Shikari et al. [5], who emphasized its contribution to tear film instability and chronic ocular surface inflammation. Westenskow et al. [6] further supported this by demonstrating that gland dysfunction is directly linked to higher Oxford Staining Scores, indicating more pronounced epithelial damage. The importance of early intervention is underscored by Wolff et al. [7], who recommended routine screening for ocular involvement in cGVHD patients to mitigate long-term damage. Kim et al. [8] advocated for a multi-modal diagnostic approach, suggesting that comprehensive evaluations improve clinical outcomes by preventing disease progression. Collectively, these findings emphasize the necessity of standardized ocular surface evaluations in cGVHD management to enhance patient quality of life and preserve visual function.

Ocular Surface Disease is a common and debilitating manifestation in patients with chronic Graft-Versus-Host Disease. Early and comprehensive ocular surface evaluation can significantly improve patient outcomes and quality of life through timely therapeutic interventions.

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