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  • Review Article
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The ocular graft-versus-host disease: the path from current knowledge to future managements

Eye volume 37, pages 1982–1992 (2023)Cite this article

Subjects

Abstract

Background

Graft-versus-host disease (GVHD) is one of the major complications of allogenic haematopoietic stem cell transplantation (HSCT). The manifestation of ocular GVHD (oGVHD) is variable and may involve cornea, lacrimal gland, conjunctiva, eyelid, and/or nasolacrimal duct. We reviewed and summarized the current managements of oGVHD with specific focus on the emerging therapeutic advances.

Methods

PubMed, Web of Science, and Google Scholar were searched for relevant literatures published within 20 years. Keywords used included “Graft-Versus-Host Disease”, “GVHD”, “ocular”, “ocular surface”, “ocular GVHD”, “oGVHD”, “dry eye”, “keratitis”, etc.

Results

Current managements of oGVHD can be classified into topical immunosuppressants, local tear-preservatory treatments, local non-pharmacological/surgical interventions, and systemic treatments. Additionally, some innovative therapies with promising treatment effects have been proposed, including topical target therapies, epitheliotrophic and neurotrophic treatments, recombinant DNase eye drops, mesenchymal stromal cell injection, and more.

Conclusions

Clinical managements of oGVHD are administered in a symptom-based, stepwise manner. The advances in innovative therapies may help improve clinical outcomes, and it is essential that physicians stay updated with these novel treatment options.

摘要

移植物抗宿主病 (GVHD) 是同种异体造血干细胞移植 (HSCT) 的主要并发症之一。眼部GVHD (oGVHD) 的表型多变, 可累及角膜, 泪腺, 眼睑和/或鼻泪管。我们特别关注了最新的治疗进展, 回顾并总结了有关oGVHD的治疗。我们使用了PubMed, Web of Science和谷歌学术搜索近20年发表的相关文献。搜索的关键词包括“移植物抗宿主病”, “GVHD”, “眼部”, “眼表”, “眼部移植物抗宿主病”, “oGVHD”, “干眼症”, “角膜炎”等。目前为止, oGVHD的治疗方法可以分为局部的免疫抑制治疗, 局部泪液的保留治疗, 局部非药物/手术干预和全身治疗。此外, 也有一些有前途的创新性的治疗方法相继提出, 包括局部靶向治疗法, 上睑萎缩和神经营养治疗, 重组DNase滴眼液, 间充质基质细胞注射等。总之, oGVHD是基于症状逐步进行临床治疗的。创新疗法的进步可能对临床产出有所帮助, 对于医生来说, 持续更新并了解这些全新的治疗方案是十分必要的。

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Fig. 1: Ocular manifestation of chronic oGVHD.
Fig. 2: The pathogenesis and signalling pathways involved in oGVHD, with examples of the therapeutic targets of innovative treatments.
Fig. 3: Representative external eye photos of chronic oGVHD.
Fig. 4: The algorithm of oGVHD managements.

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Authors and Affiliations

  1. School of Medicine, National Taiwan University, Taipei, Taiwan

    Tung-Lin Chiang & Ying-Tung Hsieh

  2. Department of Ophthalmology, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan

    Yi-Chen Sun

  3. College of Medicine, Tzu Chi University, Hualien, Taiwan

    Yi-Chen Sun

  4. Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA

    Jo-Hsuan Wu

  5. Department of Ophthalmology, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan

    Wei-Lun Huang

  6. Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

    Wei-Lun Huang

  7. Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan

    Wei-Li Chen

  8. Advanced Ocular Surface and Corneal Nerve Regeneration Centre, National Taiwan University Hospital, Taipei, Taiwan

    Wei-Li Chen

  9. Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan

    Wei-Li Chen

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  1. Tung-Lin Chiang
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  2. Yi-Chen Sun
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  4. Ying-Tung Hsieh
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  5. Wei-Lun Huang
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Contributions

TLC was responsible for designing the review protocol, conducting the search, screening potentially eligible studies, analysing the studies, writing the main article, updating reference lists, creating Tables 3, 4, and Fig. 4, and approving the final manuscript. YCS contributed to designing the review protocol, conducting the search, screening potentially eligible studies, writing the main article, and approving the final manuscript. JHW contributed to designing the review protocol, providing a critical revision to the manuscript, creating Tables 3, 4, and approving the final manuscript. TYH was responsible for providing a critical revision to the manuscript, drawing Fig. 1 and the Fig. 2, and approving the final manuscript. WLH contributed to designing the review protocol, writing the main article, reviewing the structure and providing feedback on the main article, and approving the final manuscript. WLC was responsible for designing the review protocol, screening potentially eligible studies, providing a critical revision to the manuscript, creating Tables 3, 4, and approving the final manuscript.

Corresponding author

Correspondence to Wei-Li Chen.

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Chiang, TL., Sun, YC., Wu, JH. et al. The ocular graft-versus-host disease: the path from current knowledge to future managements. Eye 37, 1982–1992 (2023). https://doi.org/10.1038/s41433-022-02288-9

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  • DOI: https://doi.org/10.1038/s41433-022-02288-9

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