Prevalence of PersistentCorneal Epithelial Defects in Chronic Ocular Graft- Versus-Host Disease

Abstract Purpose To establish the prevalence, clinical characteristics, and risk factors for persistent corneal epithelial defects (PED) in patients with chronic ocular graft-versus-host disease (oGVHD) and to determine visual outcomes after healing. Design Retrospective cohort study Methods We performed a chart review of patients diagnosed with chronic oGVHD between January 2011 and December 2018, and recorded their demographic and clinical characteristics. The data were analyzed to determine prevalence of PED and multivariate logistic regression was performed to determine the risk factors associated with it. Results We identified 405 patients diagnosed with chronic oGVHD with a mean age of 60±13 years; 58% were men. The prevalence of PED was 8.1%; the median time for PED development after hematopoietic stem cell transplantation was approximately 24 months. Median time to PED resolution was 4.5 weeks after starting therapy. The mean best-corrected visual acuity declined by two lines post-PED resolution. The prevalence rates of corneal ulcer and perforation were 6.2% and 4.0%, respectively, over eight years. Logistic regression analysis to determine factors associated with PED showed diabetes (p=0.006), limbal stem cell deficiency (LSCD) (p=0.02), filamentary keratitis(p=0.02), subconjunctival fibrosis(p=0.02) and a higher oGVHD NIH score(p=0.01) to be significant risk factors for PED development. Conclusions We found the prevalence rate of PED, corneal ulceration and corneal perforation in chronic oGVHD to be 8.1%, 6.2%, and 4%, respectively. Our analysis shows that oGVHD patients with diabetes, LSCD, filamentary keratitis, subconjunctival fibrosis and a high NIH score are at higher risk of developing severe corneal disease.