Mittelviefhaus H, Auw-Hädrich C
Universitätsaugenklinik Freiburg.
Ophthalmologe. 2003 Mar;100(3):222-9. doi: 10.1007/s00347-002-0727-5.
To evaluate the incidence and clinical course of corneal complications in patients with severe dry eye syndrome after hematopoietic stem cell transplantation (HSCT).
50 consecutive patients (aged 9-65 years; average=42+/-11 years) with Sjögren-like syndrome after hematopoietic stem cell transplantation were examined. In order to assess the severity of the dry eye syndrome, the frequency of blinking and break-up time were determined and Schirmer-I, fluorescein,and rose bengal tests were carried out. Biopsy and histological examination were performed in cases with suspected conjunctival graft-versus-host reaction.
Patients with Sjögren-like dry eye syndrome were referred within an average of 13 months after HSCT (SD+/-20 months).The follow-up was up to 83 months (mean: 10.2 months,SD+/-14.97). Of the 50 patients 15 developed severe corneal complications with significant loss of vision which resulted in enucleation of the eye in 1 patient. Of these 15 patients 4 had a viral and 2 a bacterial keratitis,7 had trophic corneal thinning and sterile ulcers. Two patients had limbal stem cell insufficiency or pseudomembranous conjunctivitis, both due to conjunctival graft-versus-host reaction. Another patient developed a toxic keratopathy, probably induced by cyclosporin A eye drops. Of 50 patients 35 presented with signs of an inactive or active conjunctival graft-versus-host reaction which could be proven histologically in 26 patients.
Patients with Sjögren-like dry eye syndrome after hematopoietic stem cell transplantation are at high risk to develop corneal complications.These complications may result from an aggressive extension of the graft-versus-host reaction towards the conjunctiva and/or the lacrimal gland and seem to occur more often during the period of reduction of systemic immunosuppressive therapy.Furthermore, infectious as well as trophic or toxic corneal complications may be supported by local immunosuppressive therapy. We suggest frequent ophthalmological checks of patients receiving hematopoietic stem cell transplantation who need local immunosuppressive therapy or are in the phase of reduction of systemic immunosuppressive therapy
评估造血干细胞移植（HSCT）后严重干眼症患者角膜并发症的发生率及临床病程。
对50例连续的造血干细胞移植后出现类干燥综合征的患者（年龄9 - 65岁；平均年龄 = 42±11岁）进行检查。为评估干眼症的严重程度，测定眨眼频率和泪膜破裂时间，并进行Schirmer - I试验、荧光素试验和孟加拉玫瑰红试验。对疑似结膜移植物抗宿主反应的病例进行活检和组织学检查。
类干燥综合征干眼症患者在HSCT后平均13个月（标准差±20个月）前来就诊。随访时间长达83个月（平均：10.2个月，标准差±14.97）。50例患者中，15例发生严重角膜并发症，视力显著丧失，其中1例患者眼球摘除。这15例患者中，4例为病毒性角膜炎，2例为细菌性角膜炎，7例为营养性角膜变薄和无菌性溃疡。2例患者因结膜移植物抗宿主反应出现角膜缘干细胞功能不全或假膜性结膜炎。另1例患者发生中毒性角膜病变，可能由环孢素A滴眼液引起。50例患者中，35例出现非活动性或活动性结膜移植物抗宿主反应体征，其中26例经组织学证实。
造血干细胞移植后出现类干燥综合征干眼症的患者发生角膜并发症的风险很高。这些并发症可能是由于移植物抗宿主反应向结膜和/或泪腺的侵袭性扩展所致，且似乎在全身免疫抑制治疗减量期间更常发生。此外，局部免疫抑制治疗可能会加重感染性以及营养性或中毒性角膜并发症。我们建议对接受造血干细胞移植且需要局部免疫抑制治疗或处于全身免疫抑制治疗减量阶段的患者进行频繁的眼科检查。
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