Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
Department of Ophthalmology, National Hospital Organization Saitama National Hospital, Saitama, Japan; and.
Cornea. 2021 Sep 1;40(9):1188-1192. doi: 10.1097/ICO.0000000000002593.
Ocular graft-versus-host disease (GVHD) is one of the most severe complications of hematopoietic stem cell transplantation. It manifests as an impairment of the ocular surface, such as severe dry eye disease, and deteriorates the recipient's visual function and quality of life. We encountered an "overlap syndrome" of ocular GVHD, which is characterized by the presence of both acute and chronic GVHD symptoms. In this report, we present the treatment progress of the overlap syndrome in a case with ocular GVHD.
A 57-year-old man with acute myeloblastic leukemia underwent hematopoietic stem cell transplantation. Six weeks after the treatment, the recipient complained of eye pain and discharge. He was diagnosed with the overlap syndrome due to low tear volume, severe corneal epithelitis, hyperemia, and a pseudomembrane on the conjunctiva. Immune cells infiltration, fibrinoid degeneration, fibroblastic and spindle-shaped cells, and fibrosis were observed in the pathology of the pseudomembrane. The recipient was treated with topical immunosuppression and pseudomembrane removal. One week after the initial treatment, ocular GVHD improved. Twelve weeks after the treatment, the topical steroid was discontinued due to the elevation of intraocular pressure.
The assessment of conjunctival pseudomembrane in ocular GVHD is important to determine the stage of the case and to assess systemic GVHD. Furthermore, prompt removal of the pseudomembrane after diagnosis is an appropriate management to reduce the symptoms of ocular GVHD. The combination of topical steroids and immunosuppressive agents is suggested to be an effective treatment in management of overlap syndrome.
眼移植物抗宿主病（GVHD）是造血干细胞移植后最严重的并发症之一。它表现为眼表损伤，如严重的干眼症，并恶化受者的视觉功能和生活质量。我们遇到了一种“重叠综合征”的眼 GVHD，其特征是同时存在急性和慢性 GVHD 症状。在本报告中，我们介绍了一例眼 GVHD 重叠综合征的治疗进展。
一名 57 岁男性，患有急性髓系白血病，接受了造血干细胞移植。治疗后 6 周，受者主诉眼痛和分泌物。由于泪液量低、严重的角膜上皮炎、充血和结膜上的伪膜，他被诊断为重叠综合征。在伪膜的病理中观察到免疫细胞浸润、纤维蛋白样变性、成纤维细胞和梭形细胞以及纤维化。受者接受了局部免疫抑制和伪膜去除治疗。初始治疗后 1 周，眼 GVHD 改善。治疗 12 周后，由于眼压升高，停止局部使用皮质类固醇。
评估眼 GVHD 中的结膜伪膜对于确定病例分期和评估全身 GVHD 非常重要。此外，诊断后及时去除伪膜是减轻眼 GVHD 症状的适当治疗方法。建议联合使用局部皮质类固醇和免疫抑制剂治疗重叠综合征。
