Department of Ophthalmology, University Medical Center, Regensburg, Regensburg, Germany.
Cornea. 2012 Mar;31(3):299-310. doi: 10.1097/ICO.0b013e318226bf97.
Ocular chronic graft-versus-host disease (cGVHD) is one of the most frequent long-term complications after hematopoietic stem cell transplantation and is often associated with significant morbidity and reduced quality of life.
The German/Austrian/Swiss Consensus Conference on Clinical Practice in cGVHD aimed to summarize the currently available evidence for diagnosis and (topical) treatment and to summarize different treatment modalities of ocular cGVHD. The presented consensus was based on a review of published evidence and a survey on the current clinical practice including transplant centers from Germany, Austria, and Switzerland.
Ocular cGVHD often affects the lacrimal glands, the conjunctiva, the lids (including meibomian glands), and the cornea but can also involve other parts of the eye such as the sclera. Up to now, there have been no pathognomonic diagnostic features identified. The main therapeutic aim in the management of ocular cGVHD is the treatment of inflammation and dryness to relieve patients' symptoms and to maintain ocular integrity and function. Therapy should be chosen in the context of the patient's overall condition, systemic immunosuppressive therapy, symptoms, ocular surface integrity, and inflammatory activity. The consensus conference proposed new grading criteria and diagnostic recommendations for general monitoring of patients with graft-versus-host-disease for use in clinical practice.
The evidence levels for diagnosis and treatment of ocular cGVHD are low, and most of the treatment options are based on empirical knowledge. Topical immunosuppression, for example, with cyclosporine, represents a promising strategy to reduce inflammation and dryness in ocular cGVHD. Further clinical trials are necessary to elucidate risk factors for eye manifestation, complications, and visual loss and to evaluate staging criteria and diagnostic and therapeutic measures for ocular cGVHD.
眼部慢性移植物抗宿主病（cGVHD）是造血干细胞移植后最常见的长期并发症之一，常伴有显著的发病率和生活质量下降。
德国/奥地利/瑞士 cGVHD 临床实践共识会议旨在总结目前诊断和（局部）治疗的证据，并总结眼部 cGVHD 的不同治疗方式。提出的共识是基于对已发表证据的审查和对德国、奥地利和瑞士移植中心的当前临床实践的调查。
眼部 cGVHD 常累及泪腺、结膜、眼睑（包括睑板腺）和角膜，但也可累及眼睛的其他部位，如巩膜。迄今为止，尚未确定具有特征性的诊断特征。眼部 cGVHD 管理的主要治疗目标是治疗炎症和干燥，以缓解患者的症状，维持眼部完整性和功能。治疗应根据患者的整体状况、全身免疫抑制治疗、症状、眼表完整性和炎症活动情况选择。共识会议提出了新的分级标准和诊断建议，用于监测移植抗宿主病患者，以便在临床实践中使用。
眼部 cGVHD 的诊断和治疗的证据水平较低，大多数治疗选择基于经验知识。例如，局部免疫抑制治疗，如环孢素，代表了一种减少眼部 cGVHD 炎症和干燥的有前途的策略。需要进一步的临床试验来阐明眼部表现、并发症和视力丧失的风险因素，并评估眼部 cGVHD 的分期标准和诊断及治疗措施。
