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Case Reports
. 2021 Apr 7;21(1):164.
doi: 10.1186/s12886-021-01925-3.

Two case reports of continued progression of chronic ocular graft-versus-host disease without concurrent systemic comorbidities treated by amniotic membrane transplantation

Hideto Ikarashi  1 , Naohiko Aketa  2 , Eisuke Shimizu  1 , Yoji Takano  1   3 , Tetsuya Kawakita  1   4 , Yuichi Uchino  1 , Yukihiro Matsumoto  1 , Junko Ogawa  1   4 , Kazuo Tsubota  1 , Yoko Ogawa  1
Affiliations
Case Reports

Two case reports of continued progression of chronic ocular graft-versus-host disease without concurrent systemic comorbidities treated by amniotic membrane transplantation

Hideto Ikarashi et al. BMC Ophthalmol. .

Abstract

Background: Chronic ocular graft-versus-host disease (oGVHD) is an ocular comorbidity of graft-versus-host disease (GVHD) that usually occurs concurrently with systemic manifestations. Failure to detect and treat oGVHD in its early stages may lead to progression of ocular signs and symptoms leading to oGVHD that is refractory to conventional treatment.

Case presentation: We report the clinical course of a 19-year-old male and a 59-year-old female with severe and progressive chronic oGVHD without concurrent systemic signs of chronic graft-versus-host disease (cGVHD). Although their systemic conditions had been stable, both suffered from severe oGVHD and were referred to our clinic. Both cases exhibited marked improvement in conjunctival inflammation and fibrotic changes after amniotic membrane transplantation (AMT). Both cases underwent keratoplasty eventually to stabilize ocular surface conditions and to improve visual function.

Conclusions: We reported the clinical outcomes of 2 cases of chronic oGVHD without concurrent systemic comorbidities that were treated with AMT. The clinician should be aware that cGVHD may persist in target organs even in the absence of concurrent systemic comorbidities following seemingly successful systemic treatment. A multidisciplinary team approach is essential in the early detection and therapeutic intervention for chronic oGVHD.

Keywords: Amniotic membrane transplantation; Dry eye disease; Fibrosis; Inflammation; Severe ocular GVHD.

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Conflict of interest statement

Not applicable.

Figures

Fig. 1
Fig. 1
Slit-lamp micrographs before and after amniotic membrane transplantation (AMT) for a 19-year-old male with GVHD-related dry eye disease. a, b Conjunctival fibrosis and active neovascularization before AMT. c, d An AM was used to cover the ocular surface, and AM implantation at the site of fornix shortening was performed. e, f After AMT, tarsal conjunctival fibrosis subsided, and fornix was reconstructed
Fig. 2
Fig. 2
Slit-lamp micrographs before and after amniotic membrane transplantation (AMT) for a 59-year-old female with GVHD-related dry eye disease. a, b Symblepharon, fornix shortening, conjunctivalization, and neovascularization before AMT. c, d After AMT, symblepharon and conjunctivalization improved, and fornix was reconstructed. Fluorescein-stained ocular surface images before (b) and after (d) AMT
See this image and copyright information in PMC

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