Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Post-Transplant Events

Risk factors and characteristics of ocular complications, and efficacy of autologous serum tears after haematopoietic progenitor cell transplantation

Bone Marrow Transplantation volume 38, pages 223–227 (2006)Cite this article

Abstract

The objective of the study was to evaluate the frequency and clinical characteristics of ocular complications and their risk factors, as well as autologous serum tears (AST) for the treatment of dry eye in these patients. Data from the files of 124 patients who had undergone allogeneic haematopoietic progenitor cell transplantation (HPCT) were evaluated. In addition, 33 HPCT patients were examined and their data were compared with controls. Analysis of tears and AST was performed. Dry eye manifestation occurred in 32% of patients and was positively correlated with age over 27 years (P=0.05), peripheral blood progenitor cell transplant (P=0.002), chronic graft-versus-host disease (P=0.0027), and chronic or acute myeloid leukaemia (P=0.001). Dry mouth and Schirmer test <5 mm were predictive factors for dry eye in HPCT patients (P=0.002 and odds ratio 3.9 and P=0.007, odds ratio=5.9, respectively). Microbiological analysis revealed that six of 11 AST samples were contaminated after 30 days of use. The present study supports the role of potential risk factors for ocular complications and key elements to detect alterations in the tear film from HPCT patients. In addition, AST contamination must be considered after longer periods of use.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Slavin RE, Santos GW . The graft-versus-host reaction in a man after bone marrow transplantation: pathology, pathogenesis, clinical features and implication. Clin Immunol Immunopathol 1973; 1: 472–498.

    Article  CAS  PubMed  Google Scholar 

  2. Gratwohl AA, Moutsopoulos HM, Chused TM, Akizuki M, Wolf RO, Sweet JB et al. Sjögren-type syndrome after allogeneic bone-marrow transplantation. Ann Intern Med 1977; 87: 703–706.

    Article  CAS  PubMed  Google Scholar 

  3. Franklin RM, Kenyon KR, Tutschka PJ, Saral R, Green WR, Santos GR . Ocular manifestations of graft-vs-host disease. Ophthalmol 1983; 90: 4–13.

    Article  CAS  Google Scholar 

  4. Sullivan KM . Graft-versus-host disease. In: Forman SJ, Blume KG, Thomas ED (eds). Bone Marrow Transplantation. Blackwell Scientific Publications: Boston, 1994, pp 339–362.

    Google Scholar 

  5. Bradfield YS, Kushner BJ, Gangnon RE . Ocular complications after organ and bone marrow transplantation in children. J AAPOS 2005; 9: 426–432.

    Article  PubMed  Google Scholar 

  6. Calissendorff B, el-Azazi M, Lonnqvist B . Dry eye syndrome in long-term follow-up of bone marrow transplanted patients. Bone Marrow Transplant 1989; 4: 675–678.

    CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Rocha EM, Wickham LA, Huang Z, Toda I, Gao J, da Silveira LA et al. Presence and testosterone influence on the levels of anti- and pro-inflammatory cytokines in lacrimal tissues of a mouse model of Sjögren's syndrome. Adv Exp Med Biol 1998; 438: 485–491.

    Article  CAS  PubMed  Google Scholar 

  9. Rocha EM, Cunha DA, Carneiro EM, Boschero AC, Saad MJ, Velloso LA . Identification of insulin in the tear film and insulin receptor and IGF-1 receptor on the human ocular surface. Invest Ophthalmol Vis Sci 2002; 43: 963–967.

    PubMed  Google Scholar 

  10. Cunha DA, Carneiro EM, Alves MD, Jorge AG, Sousa SM, Boschero AC et al. Insulin secretion by rat lacrimal glands: effects of systemic and local variables. Am J Physiol Endocrinol Metab 2005; 289: E768–E775.

    Article  CAS  PubMed  Google Scholar 

  11. Ogawa Y, Yamazaki K, Kuwana M, Mashima Y, Nakamura Y, Ishida S 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 

  12. Stem Cell Trialists' Collaborative Group. Allogeneic peripheral blood stem-cell compared with bone marrow transplantation in the management of haematologic malignancies: an individual patient data meta-analysis of nine randomized trials. J Clin Oncol 2005; 23: 5074–5087.

  13. Vigorito AC, Marques Junior JF, Aranha FJ, Oliveira GB, Miranda EC, De Souza CA . A randomized, prospective comparison of allogeneic bone marrow and peripheral blood progenitor cell transplantation in the treatment of hematologic malignancies: an update. Haematologica 2001; 86: 665–666.

    CAS  PubMed  Google Scholar 

  14. Vigorito AC, Azevedo WM, Marques JFC, Azevedo AM, Eid KAB, Aranha FJP et al. A randomized, prospective comparison of allogeneic bone marrow and peripheral blood progenitor cell transplantation in the treatment of hematologic malignancies. Bone Marrow Transplant 1998; 22: 1145–1151.

    Article  CAS  PubMed  Google Scholar 

  15. Aranha FJ, Vigorito AC, De Sousa CA, Oliveira GB, Zulli R, Lorand-Metze I . The influence of the graft monocytes in the outcome of allogeneic bone marrow transplantation. Haematologica 2002; 87: 219–220.

    PubMed  Google Scholar 

  16. Rocha EM, Paiva CS, Pelegrino FSA, Vigorito AC, Souza CA . GvHD dry eye treated with serum tears. Bone Marrow Transplant 2000; 25: 1101–1104.

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Lemp MA . Report of the national eye institute/industry workshop on clinical trials in dry eyes. CLAO J 1995; 21: 221–232.

    CAS  PubMed  Google Scholar 

  19. Sullivan KM, Shulman HM, Storb R, Weiden PL, Witherspoon RP, McDonald GB et al. Chronic graft-versus-host disease in 52 patients: adverse natural course and successful treatment with combination immunosuppression. Blood 1981; 57: 267–276.

    CAS  PubMed  Google Scholar 

  20. Sullivan DA, Wickham LA, Rocha EM, Krenzer KL, Sullivan BD, Steagall R et al. Androgens and dry eye in Sjögren's syndrome. Ann NY Acad Sci 1999; 876: 312–324.

    Article  CAS  PubMed  Google Scholar 

  21. Sale GE, Shulman HM, Schubert MM, Sullivan KM, Kopecky KJ, Hackman RC et al. Oral and ophthalmic pathology of graft versus host disease in man: predictive value of the lip biopsy. Hum Pathol 1981; 12: 1022–1030.

    Article  CAS  PubMed  Google Scholar 

  22. Jabs DA, Wingard J, Green WR, Farmer ER, Vogelsang G, Saral R . The eye in bone marrow transplantation. III. Conjunctival graft-vs-host disease. Arch Ophthalmol 1989; 107: 1343–1348.

    Article  CAS  PubMed  Google Scholar 

  23. Alborghetti MR, Correa ME, Adam RL, Metze K, Coracin FL, de Souza CA et al. Late effects of chronic graft-vs-host disease in minor salivary glands. J Oral Pathol Med 2005; 34: 486–493.

    Article  CAS  PubMed  Google Scholar 

  24. Nichols KK, Nichols JJ, Mitchell GL . The lack of association between signs and symptoms in patients with dry eye disease. Cornea 2004; 23: 762–770.

    Article  PubMed  Google Scholar 

  25. Lucca JA, Nunez JN, Farris RL . A comparison of diagnostic tests for keratoconjunctivitis sicca: lactoplate, Schirmer, and tear osmolarity. CLAO J 1990; 16: 109–112.

    CAS  PubMed  Google Scholar 

  26. Kojima T, Ishida R, Dogru M, Goto E, Matsumoto Y, Kaido M et al. The effect of autologous serum eyedrops in the treatment of severe dry eye disease: a prospective randomized case–control study. Am J Ophthalmol 2005; 139: 242–246.

    Article  PubMed  Google Scholar 

  27. Ogawa Y, Okamoto S, Mori T, Yamada M, Mashima Y, Watanabe R et al. Autologous serum eye drops for the treatment of severe dry eye in patients with chronic graft-versus-host disease. Bone Marrow Transplant 2003; 31: 579–583.

    Article  CAS  PubMed  Google Scholar 

  28. Schein OD, Hbberd PL, Starck T, Baker AS, Kenyon KR . Microbial contamination of in-use ocular medications. Arch Ophthalmol 1992; 110: 82–85.

    Article  CAS  PubMed  Google Scholar 

  29. Lagnado R, King AJ, Donald F, Dua HS . A protocol for low contamination risk of autologous serum drops in the management of ocular surface disorders. Br J Ophthalmol 2004; 88: 464–465.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Sauer R, Bluthner K, Seitz B . Sterility of non-preserved autologous serum drops for treatment of persistent corneal epithelial defects. Ophthalmologe 2004; 101: 705–709.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology & Otorhinolaryngology, State University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil

    S C Leite, R S de Castro & E M Rocha

  2. Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil

    M Alves & L A da Silveira

  3. Department of Physiology, Institute of Biology, State University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil

    D A Cunha

  4. Bone Marrow Transplantation Unit, Center of Hematology and Hemotherapy, State University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil

    M E P Correa, A C Vigorito & C A de Souza

  5. Department of Ophthalmology, Otorhinolaryngology and Head & Neck Surgery, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil

    E M Rocha

Authors
  1. S C Leite
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R S de Castro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M Alves
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D A Cunha
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M E P Correa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L A da Silveira
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A C Vigorito
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. C A de Souza
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. E M Rocha
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E M Rocha.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leite, S., de Castro, R., Alves, M. et al. Risk factors and characteristics of ocular complications, and efficacy of autologous serum tears after haematopoietic progenitor cell transplantation. Bone Marrow Transplant 38, 223–227 (2006). https://doi.org/10.1038/sj.bmt.1705426

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1705426

Keywords

This article is cited by

Search

Advanced search

Quick links