Kiang E, Tesavibul N, Yee R, Kellaway J, Przepiorka D
Hermann Eye Center, University of Texas-Houston Health Science Center, USA.
Bone Marrow Transplant. 1998 Jul;22(2):147-51. doi: 10.1038/sj.bmt.1701304.
Ocular manifestations of GVHD include keratoconjunctivitis sicca, cicatricial lagophthalmos, sterile conjunctivitis, persistent corneal epithelial defects, corneal ulcers and corneal melting. Conventional initial therapy such as lubrication and topical steroids is directed to treat decreased tear production and ocular surface abnormalities. The purpose of this study was to illustrate the possible benefit of topical cyclosporin A 1% (CsA) as an adjunct in managing ocular surface abnormalities in five cases of GVHD refractory to conventional therapy. Five clinical case reports of chronic GVHD patients in whom conventional therapy was inadequate to stop the progression from its initial presentation are described. Patient presentation varied in severity on a spectrum of mild to moderate diffuse punctate epithelial erosions to sterile necrotizing corneal melts. Although systemic therapy for GVHD consisting of systemic immunosuppressants (ie cyclosporin A and corticosteroids) was given to these patients, this therapy was insufficient in managing the ocular manifestations of the disease. Topical CsA was added to the treatment regimen and the progression of the ocular disease was recorded. The addition of topical CsA 1% probably helped in controlling the epithelial keratitis and melting process in our reported cases and we conclude that topical CsA may be an appropriate modality in managing ocular surface abnormalities in patients with ocular GVHD after conventional treatments have been tried. However, a further randomized clinical prospective study is needed to evaluate the efficacy of topical CsA in managing these problems in GVHD patients.
移植物抗宿主病（GVHD）的眼部表现包括干燥性角结膜炎、瘢痕性兔眼、无菌性结膜炎、持续性角膜上皮缺损、角膜溃疡和角膜溶解。常规的初始治疗，如润滑和局部使用类固醇，旨在治疗泪液分泌减少和眼表异常。本研究的目的是说明1%环孢素A（CsA）局部用药作为辅助治疗对5例常规治疗无效的GVHD患者眼表异常的可能益处。描述了5例慢性GVHD患者的临床病例报告，这些患者的常规治疗不足以阻止病情从最初表现进展。患者表现的严重程度各不相同，从轻度到中度弥漫性点状上皮糜烂到无菌性坏死性角膜溶解。尽管这些患者接受了由全身免疫抑制剂（即环孢素A和皮质类固醇）组成的GVHD全身治疗，但这种治疗不足以控制该疾病的眼部表现。在治疗方案中加入局部用CsA，并记录眼部疾病的进展。在我们报告的病例中，添加1%局部用CsA可能有助于控制上皮性角膜炎和溶解过程，我们得出结论，在尝试常规治疗后，局部用CsA可能是治疗眼部GVHD患者眼表异常的一种合适方法。然而，需要进一步的随机临床前瞻性研究来评估局部用CsA治疗GVHD患者这些问题的疗效。
