Sepulveda-Beltran Paula A, Carletti Piero, Banda Victor, Mulpuri Lakshman, Levine Harry, Amescua Guillermo, Wang Trent P, Galor Anat, Tonk Rahul
From the Bascom Palmer Eye Institute, Department of Ophthalmology (P.A.S.-B., P.C., V.B., L.M., H.L., G.A., A.G., R.T.).
Sylvester Comprehensive Cancer Center, Division of Transplantation and Cell Therapy, Department of Medicine (T.P.W.), University of Miami Miller School of Medicine, Miami, Florida, USA.
Am J Ophthalmol. 2024 Jan;257:236-246. doi: 10.1016/j.ajo.2023.09.018. Epub 2023 Sep 28.
To evaluate the incidence, clinical characteristics, microbiological profile, and therapeutic outcomes of corneal ulcers in individuals with chronic ocular graft-vs-host disease (coGVHD).
Retrospective clinical cohort study.
Review of individuals diagnosed with coGVHD following hematopoietic stem cell transplantation (HSCT) who were seen at the Bascom Palmer Eye Institute between May 2010 and November 2021. Baseline demographics, clinical characteristics, microbiological profile, risk factors for corneal ulceration, and treatment outcomes were collected. Etiology was deemed infectious in individuals with a positive culture or appropriate clinical scenario (presence of stromal infiltrate or hypopyon); otherwise, ulcers were presumed to be noninfectious. Treatment success was defined as reepithelialization with infiltrate resolution, and treatment failure as progression to corneal perforation or keratoplasty. Kaplan-Meier survival analysis estimated the incidence of ulceration. Cox regression analyses examined demographic and risk factors. Infectious and noninfectious ulcer groups were compared using 2-way independent t tests, 1-way analysis of variances, and χ tests, as appropriate.
173 individuals were included (53.7±14.4 years old; 59.0% male). Thirty-three individuals developed an ulcer 74.5±54.3 months after HSCT, with estimated 5- and 10-year incidences of 14% and 30%, respectively. Twenty-two (66.6%) ulcers were deemed infectious (15 microbiologically confirmed, 7 clinically) and 11 (33.3%) were deemed noninfectious. Risk factors for corneal ulceration included Black race (hazards ratio [HR] 2.89, 95% CI 1.30-6.42, P < .01), previous ocular surgery (HR 9.16, 95% CI 3.86-21.72, P < .01), eyelid margin abnormalities (HR 3.44, 95% CI 1.69-6.99, P < .01), and topical steroid use (HR 2.74, 95% CI 1.33-5.62, P < .01). Conversely, contact lens use reduced the risk of corneal ulceration (HR 0.29, 95% CI 0.13-0.66, P < .01). Infectious ulcers had a significantly higher frequency of treatment failure than noninfectious ulcers (57.1% vs 20.0%, P = .04).
Corneal ulceration is a potential complication of coGVHD, with several clinical features identified as risk factors. Infectious ulcers had worse outcomes than noninfectious ulcers.
评估慢性眼部移植物抗宿主病（coGVHD）患者角膜溃疡的发病率、临床特征、微生物学特征及治疗效果。
回顾性临床队列研究。
对2010年5月至2021年11月在巴斯科姆·帕尔默眼科研究所就诊的造血干细胞移植（HSCT）后被诊断为coGVHD的患者进行回顾。收集基线人口统计学资料、临床特征、微生物学特征、角膜溃疡的危险因素及治疗效果。对于培养阳性或有合适临床情况（存在基质浸润或前房积脓）的患者，病因判定为感染性；否则，溃疡被认为是非感染性的。治疗成功定义为上皮化且浸润消退，治疗失败定义为进展至角膜穿孔或角膜移植。Kaplan-Meier生存分析估计溃疡的发病率。Cox回归分析检查人口统计学和危险因素。根据情况，使用双因素独立t检验、单因素方差分析和χ检验对感染性和非感染性溃疡组进行比较。
纳入173例患者（年龄53.7±14.4岁；59.0%为男性）。33例患者在HSCT后74.5±54.3个月发生溃疡，估计5年和10年发病率分别为14%和30%。22例（66.6%）溃疡被认为是感染性的（15例经微生物学证实，7例临床诊断），11例（33.3%）被认为是非感染性的。角膜溃疡的危险因素包括黑人种族（风险比[HR]2.89，95%可信区间1.30 - 6.42，P <.01）、既往眼部手术（HR 9.16，95%可信区间3.86 - 21.72，P <.01）、睑缘异常（HR 3.44，95%可信区间1.69 - 6.99，P <.01）和局部使用类固醇（HR 2.74，95%可信区间1.33 - 5.62，P <.
