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Graft-Versus-Host Disease

Autologous serum eye drops for the treatment of severe dry eye in patients with chronic graft-versus-host disease

Summary:

We investigated the efficacy and safety of autologous serum eye drops for the treatment of severe dry eye after allogeneic haematopoietic stem cell transplantation (SCT). A total of 14 patients (four males and 10 females; median age, 31.0 years) with severe dry eye associated with chronic graft-versus-host disease (cGVHD) were enrolled in this study. All patients were refractory to treatment with conventional artificial tears. Autologous serum eye drops, a solution made of 20% autologous serum in sterile saline, were applied 10 times per eye per day. The patients were evaluated every 4 weeks according to visual acuity, corneal sensitivity, vital staining of the ocular surface, tear dynamics, and subjective assessments of symptoms (complaints scores). The median follow-up period was 19.4 months (range: 4–41 months). After 4 weeks of treatment, significant improvement was observed in both complaint scores (from 33.7±12.3 to 23.6±10.6 points; P<0.01) and fluorescein scores (from 5.8±2.0 to 2.4±0.9 points; P<0.005). Significant improvements were observed also in rose-bengal staining and tear break-up time. In seven of the 14 patients, the responses were maintained for 6–41 months (median:19.4±8.3 months), while six of the other seven patients required treatment with punctal plugs in addition to autologous serum eye drops. One of these other seven patients developed eczema around the eyelids, after which the treatment was discontinued. No serious adverse events were observed. We conclude that autologous serum eye drops are safe and effective for treating severe dry eye associated with cGVHD and that more efficient control of dry eye may be achieved by the combined use of autologous serum eye drops with punctal plugs.

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References

  1. Shulman HM, Sullivan KM, Weiden PL et al. Chronic graft-versus-host syndrome in man. A long-term clinicopathologic study of 20 Seattle patients. Am J Med 1980; 69: 204–217.

    Article  CAS  Google Scholar 

  2. Ogawa Y, Okamoto S, Wakui M et al. Dry eye after haematopoietic stem cell transplantation. Br J Ophthalmol 1999; 83: 1125–1130.

    Article  CAS  Google Scholar 

  3. Murphy PT, Sivakumaran M, Fahy G et al. Successful use of topical retinoic acid in severe dry eye due to chronic graft-versus-host disease. Bone Marrow Transplant 1996; 18: 641–642.

    CAS  Google Scholar 

  4. Ogawa Y, Okamoto S, Kuwana M et al. Successful treatment of dry eye in two patients with chronic graft-versus-host disease with systemic administration of FK506 and corticosteroid. Cornea 2001; 20: 430–434.

    Article  CAS  Google Scholar 

  5. Rocha EM, Pelegrino FS, de Paiva CS et al. GVHD dry eyes treated with autologous serum tears. Bone Marrow Transplant 2000; 25: 1101–1103.

    Article  CAS  Google Scholar 

  6. Fox RI, Chan R, Michelson JB et al. Beneficial effect of artificial tears made with autologous serum in patients with keratoconjunctivitis sicca. Arthritis Rheum 1984; 27: 459–461.

    Article  CAS  Google Scholar 

  7. Tsubota K, Goto E, Fujita H et al. Treatment of dry eye by autologous serum application in Sjögren's syndrome. Br J Ophthalmol 1999; 83: 390–395.

    Article  CAS  Google Scholar 

  8. Tananuvat N, Daniell M, Sullivan LJ et al. Controlled study of the use of autologous serum in dry eye patients. Cornea 2001; 20: 802–806.

    Article  CAS  Google Scholar 

  9. Tsubota K, Goto E, Shimmura S et al. Treatment of persistent corneal epithelial defect by autologous serum application. Ophthalmology 1999; 106: 1984–1989.

    Article  CAS  Google Scholar 

  10. Goto E, Shimmura S, Shimazaki J et al. Treatment of superior limbic keratoconjunctivitis by application of autologous serum. Cornea 2001; 20: 807–810.

    Article  CAS  Google Scholar 

  11. Tsubota K, Satake Y, Ohyama M et al. Surgical reconstruction of the ocular surface in advanced ocular cicatricialpemphigoid and Stevens-Johnson syndrome. Am J Ophthalmol 1996; 122: 38–52.

    Article  CAS  Google Scholar 

  12. van Setten GB, Viinikka L, Tervo T et al. Epidermal growth factor is a constant component of normal human tear fluid. Graefe's Arch Clin Exp Ophthalmol 1989; 227: 184–187.

    Article  CAS  Google Scholar 

  13. Poon AC, Geerling G, Dart JK et al. Autologous serum eyedrops for dry eyes and epithelial defects: clinical and in vitro toxicity studies. Br J Ophthalmol 2001; 85: 1188–1197.

    Article  CAS  Google Scholar 

  14. Tsubota K . The importance of the Schirmer test with nasal stimulation test. Am J Ophthalmol 1991; 111: 106–108.

    Article  CAS  Google Scholar 

  15. Tsubota K, Toda I, Yagi Y et al. Three different types of dry eye syndrome. Cornea 1994; 13: 202–209.

    Article  CAS  Google Scholar 

  16. Ohashi Y, Motokura M, Kinoshita Y et al. Presence of epidermal growth factor in human tears. Invest Ophthalmol Vis Sci 1989; 30: 1879–1882.

    CAS  PubMed  Google Scholar 

  17. Woost P, Jumblatt M, Eiferman R et al. Growth factors and corneal endothelial cells: II. Characterization of epidermal growth factor receptor from bovine corneal endothelial cells. Cornea 1992; 11: 11–19.

    Article  CAS  Google Scholar 

  18. Lipps BV . Isolation of nerve growth factor (NGF) from human body fluids; saliva, serum and urine comparison between cobra venom and cobra serum NGF. J Nat Toxins 2000; 9: 349–356.

    CAS  PubMed  Google Scholar 

  19. Kunert KS, Tisdale AS, Stern ME et al. Analysis of topical cyclosporine treatment of patients with dry eye syndrome: effect on conjunctival lymphocytes. Arch Ophthalmol 2000; 118: 1489–1496.

    Article  CAS  Google Scholar 

  20. Gordonson LC . Efficacy and tolerability outcomes after punctal occlusion with silicone plugs in dry eye syndrome. Am J Ophthalmol 2001; 132: 600–601.

    Article  CAS  Google Scholar 

  21. Balaram M, Schaumberg DA, Dana MR . Efficacy and tolerability outcomes after punctal occlusion with silicone plugs in dry eye syndrome. Am J Ophthalmol 2001; 131: 30–36.

    Article  CAS  Google Scholar 

  22. Pratt DV, Patrinely JR . Reversal of iatrogenic punctal and canalicular occlusion. Ophthalmology 1996; 103: 1493–1497.

    Article  CAS  Google Scholar 

  23. Ogawa Y, Yamazaki K, Kuwana M et al. A significant role of stromal fibroblasts in rapidly progressive dry eye in patients with chronic GVHD. Invest Ophthalmol Vis Sci 2001; 42: 111–119.

    CAS  PubMed  Google Scholar 

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Acknowledgements

We thank the residents of the Department of Ophthalmology, Keio University School of Medicine, for preparing the artificial tears using autologous serum for the patients. This study was presented at the Annual Meeting of the Association for Research in Vision and Ophthalmology at ARVO 2001 in Fort Lauderdale in Florida, USA, and received ARVO/KOWA Travel Grantship Award.

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Ogawa, Y., Okamoto, S., Mori, T. et al. Autologous serum eye drops for the treatment of severe dry eye in patients with chronic graft-versus-host disease. Bone Marrow Transplant 31, 579–583 (2003). https://doi.org/10.1038/sj.bmt.1703862

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