[Ophthalmologic findings in graft versus host disease (GvHD)]

Abstract

Background: Since the era of bone marrow transplantation, the picture of acute and/or chronic transplant reaction of the host cells against grafted bone marrow has become more frequent. The so-called adaptive immune therapy bases on the fact that patients who present with a low grade of GvHD less often suffer from a relapse of the malignant leukaemic disease. Therefore, new therapeutic regimen are now performed which keep the patient on a low level of GvHD to prevent a recurrence of leukaemia. Here a close cooperation of oncologists and ophthalmologists becomes more and more important to estimate the stage of GvHD.

Patients: Demonstrating two case reports, we report on the ophthalmological symptoms of acute and chronic GvHD. Both patients presented with acute ocular GvHD as well as with signs of chronic ocular GvHD. Concerning the ophthalmological symptoms, in acute or chronic GvHD the conjunctival involvement is most important. There is a lymphocytic infiltration of the conjunctiva and of the lacrimal glands which leads to an extreme sicca-syndrome. The acute GvHD of the conjunctiva can be classified into 4 stages: injection/exudation and chemosis/formation of pseudomembranes/defects of the corneal epithelium. These stages correlate directly to the prognosis of the survival time of the patient. A pathognomonic sign for the chronic GvHD of the conjunctiva are the fibrous-scarry Arlt-lines of the tarsal conjunctiva.

Conclusions: All patients who underwent a bone marrow transplantation for leukaemia need to be followed up closely to estimate the level of GvHD they are in. This applies especially to those patients who are treated according to the regimen of adaptive immune therapy. A close cooperation of oncologists and ophthalmologists during adaptive immune therapy is mandatory, as the ophthalmologist can provide important information to help to grade the level of GvHD, judging by the morphological picture at the slit lamp.