Munir Saleha Z, Aylward James
*OD, FAAO Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore Maryland (SZM), and Optometry, VA Boston Healthcare System, Boston, Massachusetts (JA).
Optom Vis Sci. 2017 May;94(5):545-555. doi: 10.1097/OPX.0000000000001071.
: Graft-versus-host disease (GVHD) is a major complication that occurs following allogeneic hematopoietic stem cell transplantation, which is a potential curative therapy used in a variety of malignant or benign hematological diseases. Graft-versus-host disease primarily occurs in many organs, but most notably in the skin, lungs, gastrointestinal tract, liver, eyes, mucosa, and musculoskeletal system. Ocular manifestations of GVHD may precede other systemic GVHD findings, and it may be a poor prognosis for mortality. While all parts of the eye may be affected, ocular GVHD occurs primarily in the ocular surface. Dry eye disease or keratoconjunctivitis sicca is the most common presenting manifestation of chronic ocular GVHD. Dry eye disease in ocular GVHD is a multifactorial process, which involves destruction and fibrosis of lacrimal glands and conjunctiva, leading to tear film deficiency and instability. Depending on the severity of ocular involvement and response to treatment, ocular GVHD may cause decreased quality of life. Management of GVHD begins with prevention by understanding risk factors and by implementing prophylactic treatment after allogeneic hematopoietic stem cell transplantation. A multidisciplinary approach to the prevention and treatment of GVHD is important, and there are currently no preventive therapies available for ocular GVHD. Once diagnosed, ocular GVHD treatment strategies target ocular surface lubrication and support, tear film stabilization, inflammation reduction, and surgical intervention. The goal of this review is to define ocular GVHD and its categorical manifestations, as well as to describe the importance of comprehensive assessment, diagnosis, and ophthalmologic treatment and management of ocular GVHD with a multidisciplinary approach.
移植物抗宿主病（GVHD）是异基因造血干细胞移植后发生的一种主要并发症，而异基因造血干细胞移植是用于多种恶性或良性血液系统疾病的一种潜在的治愈性疗法。移植物抗宿主病主要发生在许多器官，但最显著的是皮肤、肺、胃肠道、肝脏、眼睛、黏膜和肌肉骨骼系统。移植物抗宿主病的眼部表现可能先于其他全身性移植物抗宿主病的表现，并且其死亡率预后可能较差。虽然眼睛的所有部位都可能受到影响，但眼部移植物抗宿主病主要发生在眼表。干眼症或干燥性角结膜炎是慢性眼部移植物抗宿主病最常见的表现形式。眼部移植物抗宿主病中的干眼症是一个多因素过程，涉及泪腺和结膜的破坏与纤维化，导致泪膜缺乏和不稳定。根据眼部受累的严重程度和对治疗的反应，眼部移植物抗宿主病可能会导致生活质量下降。移植物抗宿主病的管理首先是通过了解风险因素并在异基因造血干细胞移植后实施预防性治疗来进行预防。采用多学科方法预防和治疗移植物抗宿主病很重要，目前尚无针对眼部移植物抗宿主病的预防性疗法。一旦确诊，眼部移植物抗宿主病的治疗策略旨在实现眼表润滑与支持、泪膜稳定、减轻炎症以及手术干预。本综述的目的是定义眼部移植物抗宿主病及其分类表现，以及描述采用多学科方法对眼部移植物抗宿主病进行综合评估、诊断、眼科治疗和管理的重要性。
