Rapoport Yuna, Freeman Thomas, Koyama Tatsuki, Engelhardt Brian G, Jagasia Madan, Savani Bipin N, Tran Uyen, Kassim Adetola A
*Vanderbilt Eye Institute, Vanderbilt University School of Medicine, Nashville, TN; †Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Boston, MA; ‡Department of Medicine, Division of Hematology/Oncology, Vanderbilt University School of Medicine, Nashville, TN; and §Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN.
Cornea. 2017 Feb;36(2):258-263. doi: 10.1097/ICO.0000000000001109.
To validate the International Chronic Ocular GVHD Consensus Group (ICCGVHD) diagnostic criteria for chronic ocular chronic graft-versus-host disease (GVHD), by comparing results with comprehensive ophthalmic evaluation after allogeneic hematopoietic stem cell transplantation.
A single-institution retrospective chart review was conducted on patients who underwent hematopoietic stem cell transplantation at Vanderbilt University Medical Center in Nashville, TN, from January 1, 2002, through April 17, 2014. A total of 344 patients were eligible for the study. Data collected include the Schirmer test score, corneal fluorescein staining, Ocular Surface Disease Index, conjunctival injection, and presence or absence of systemic GVHD. The diagnosis of chronic ocular GVHD in each participant and determination of the overall severity score were determined based on the newly proposed ICCGVHD diagnostic criteria and compared with the best clinical practice (BCP) score.
Chronic ocular GVHD was diagnosed in 141/344 (41%) participants, of these, 86 (61%) had complete charts. Based on the BCP score, 1.2% had none, 38.4% mild, 47.7% moderate, and 12.8% had severe chronic ocular GVHD. Based on the ICCGVHD, 34.8% had none, 59.3% mild/moderate, and 5.8% had severe chronic ocular GVHD. The clinical diagnostic stages of chronic ocular GVHD by BCP and ICCGVHD criteria had slight agreement (kappa statistic 0.187, with 95% confidence interval 0.049-0.321), with a higher correlation seen in those with severe chronic ocular GVHD.
The newly proposed ICCGVHD diagnostic criteria can be used reproducibly for the diagnosis and determination of severity of chronic ocular GVHD. However, larger prospective studies are needed to further validate it.
通过将结果与异基因造血干细胞移植后的全面眼科评估结果进行比较，验证国际慢性眼部移植物抗宿主病共识组（ICCGVHD）对慢性眼部移植物抗宿主病（GVHD）的诊断标准。
对2002年1月1日至2014年4月17日在田纳西州纳什维尔范德比尔特大学医学中心接受造血干细胞移植的患者进行单机构回顾性病历审查。共有344例患者符合研究条件。收集的数据包括泪液分泌试验评分、角膜荧光素染色、眼表疾病指数、结膜充血以及是否存在全身性GVHD。根据新提出的ICCGVHD诊断标准确定每位参与者慢性眼部GVHD的诊断及总体严重程度评分，并与最佳临床实践（BCP）评分进行比较。
141/344（41%）的参与者被诊断为慢性眼部GVHD，其中86例（61%）有完整病历。根据BCP评分，1.2%无慢性眼部GVHD，38.4%为轻度，47.7%为中度，12.8%为重度慢性眼部GVHD。根据ICCGVHD，34.8%无慢性眼部GVHD，59.3%为轻度/中度，5.8%为重度慢性眼部GVHD。BCP和ICCGVHD标准对慢性眼部GVHD的临床诊断阶段一致性轻微（kappa统计量0.187，95%置信区间0.049 - 0.321），在重度慢性眼部GVHD患者中相关性更高。
新提出的ICCGVHD诊断标准可重复性地用于慢性眼部GVHD的诊断和严重程度判定。然而，需要更大规模的前瞻性研究来进一步验证。
