A Clinical Evaluation of Ocular Manifestation in Bone Marrow Transplanted Patients

ABSTRACT

During the last decade, allogeneic bone marrow transplantation(BMT) has become the treatment of choice in severe aplastic anemia and many types of leukemia. However, there are several complications such as Graft-vs-Host Disease(GVHD), infection, Host-vs-Graft Reaction(HVGR). One of the most serious late complications of BMT is GVHD. This immunological reaction is reportedly caused by donor T lymphocytes reacting against incompatible minor transplantation antigens in host tissue. The clinical manifestation of GVHD involves the skin, gastrointestinal tract, liver and mucosal membranes in the mouth and eyes. One of the most frequent ocular complication after BMT is the "dry eye syndrome" which involves conjunctiva, cornea and the lacrimal glands. The "dry eye" is characterized by subjective symptoms such as pain, foreign body sensation and decreased vision. The epithelial degeneration, due to reduced tear production and alteration in the tear film, creates dry spots and increased mucus strands and debris. We present an analysis of ocular manifestation of 27 out of 81 bone marrow transplanted patients for hematologic malignancies(HM) and severe aplastic anemia(SAA) from March 1983 to January, 1990 at St. Mary's Hospital. The results were as follows 1) 16 out of 27(59%) BMT patients developed GVHD and 14 out of 27(52%) BMT patients developed dry eyes; 2) 11 out of 16(68%) patients with GVHD developed dry eyes; whereas, 3 out of 11(27%) patients without GVHD developed dry eyes(P<0.05); 3) Four out of 10(40%) patients with a GVHD developed dry eys, whereas 7 out of 11(64%) patients with cGVHD developed dry eyes.