Kohnstam Marcus G, Surico Pier Luigi, Luo Zhonghui K
Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114, USA.
Department of Ophthalmology, Campus Bio-Medico University Hospital, 00128 Rome, Italy.
Life (Basel). 2024 Oct 17;14(10):1317. doi: 10.3390/life14101317.
Ocular graft-versus-host disease (oGVHD) affects more than half of the patients following allogeneic hematopoietic stem cell transplantation (HSCT). The disease onset and the pathogenesis of oGVHD are not well understood. We hope to identify the triggers and explore the clinical signs and symptoms of oGVHD development at the early stages.
The records of post-HSCT patients seen consecutively in a 1-year span in a single provider's clinic were reviewed. The history, symptoms, and clinical findings of the patients with erosive tarsal conjunctival lesions (ETCLs) were analyzed.
Out of the 228 patients screened, 19 had clinically witnessed ETCL in at least one eye during the period. Twelve (63%) patients had a never-before-described nodular erosion on the subtarsal conjunctiva; seven (37%) had previously described pseudomembranous erosions. The ocular symptom onset was within 1 month after immunosuppression (IS) taper, vaccination, or donor lymphocyte infusion (DLI) in 16 of the 19 patients. While 16 (84%) patients reported painless mucous discharge, only 9 (47%) reported dryness as the initial symptom. Within 6 months, only 4 (21%) had discharge but 15 (82%) patients endorsed dryness. Subepithelial conjunctival fibrosis followed ETCL immediately in situ. Corneal punctate staining increased with time, while aqueous tear production decreased.
The ETCL described is likely one of the earliest detectable findings of oGVHD and triggered by certain immunogenic events. The ocular symptoms of wet mucous discharge should be considered a warning sign for oGVHD onset, particularly when it occurs shortly after prominently immunogenic events.
眼部移植物抗宿主病（oGVHD）影响超过半数的异基因造血干细胞移植（HSCT）患者。oGVHD的发病及发病机制尚未完全明确。我们希望确定触发因素，并探索oGVHD早期发展的临床体征和症状。
回顾了在单一医疗机构门诊连续1年就诊的HSCT后患者的记录。分析了患有糜烂性睑结膜病变（ETCL）患者的病史、症状和临床检查结果。
在筛查的228例患者中，有19例在此期间至少一只眼睛出现了临床可见的ETCL。12例（63%）患者睑结膜下出现了前所未有的结节状糜烂；7例（37%）出现了先前描述的假膜性糜烂。19例患者中有16例眼部症状在免疫抑制（IS）减量、接种疫苗或供体淋巴细胞输注（DLI）后1个月内出现。虽然16例（84%）患者报告有无痛性黏液分泌物，但只有9例（47%）报告最初症状为眼干。6个月内，只有4例（21%）有分泌物，但15例（82%）患者出现眼干。ETCL后立即原位出现结膜上皮下纤维化。角膜点状染色随时间增加，而泪液分泌减少。
所描述的ETCL可能是oGVHD最早可检测到的表现之一，由某些免疫原性事件触发。湿性黏液分泌物的眼部症状应被视为oGVHD发病的警示信号，尤其是在显著的免疫原性事件后不久出现时。
