SCLERAL LENSES IN THE MANAGEMENT OF SEVERE KERATOCONJUNCTIVITIS SICCA FROM OCULAR CHRONIC GRAFT VS HOST DISEASE

Title SCLERAL LENSES IN THE MANAGEMENT OF SEVERE KERATOCONJUNCTIVITIS SICCA FROM OCULAR CHRONIC GRAFT VS HOST DISEASE
Author, Co-Author Nadia Zalatimo, Lynette Johns, Alan Kwok, Deborah Jacobs
Topic
Year
2008
Day
Friday
Program Number
85304
Room
Affiliation
VA Medical Center
Abstract BACKGROUND: Ocular chronic Graft versus Host Disease (cGVHD) is a complication of bone marrow or stem cell transplantation in the treatment of cancer. In chronic GVHD, donor T cells attack host tissues, causing symptoms ranging from dry skin, hair loss, and severe dry eye, to life threatening disease of the lung, gut, and liver. The dry eye may be refractory to conventional and aggressive therapies, including topical cyclosporine, autologous serum, and punctal cautery. Scleral lenses that vault the cornea create an expanded pre-corneal tear film and protect the cornea from the environment and lid forces. This lubrication and protection reduces symptoms and aids in the healing of the corneal surface.

CASE REPORT(S): A 39 year-old male complained of blur and light sensitivity OD. He was using artificial tears every hour for chronic dry eye. Medical history was significant for acute lymphocytic leukemia and cGVHD. Ocular history was significant for dry eye, for which he had seen numerous subspecialists and had been treated with non-preserved artificial tears, ointment, punctal plugs, and topical cyclosporine. Cauterization of the puncta had been considered but not yet performed. Visual acuity was 20/60 OD, 20/40 OS. Biomicroscopy revealed minimal tear prism and 3+ diffuse conjunctival injection OU. The cornea showed diffuse, dense SPK OU and filaments in the superior-central cornea OD. The patient was fit with the Boston Ocular Surface Prosthesis (BOSP), a custom scleral lens, which immediately and dramatically improved his comfort. He subsequently underwent cataract extraction which improved his vision to 20/20 in each eye. The patient continues to function comfortably wearing scleral lenses.

CONCLUSIONS: Scleral lenses are an effective treatment for patients with debilitating cGVHD-related keratoconjunctivitis sicca that is refractory to other treatments. In addition to improving ocular surface integrity, the BOSP improves patient quality of life by relieving pain and photophobia.
Affiliation of Co-Authors Boston Foundation for Sight, Boston Foundation for Sight, Boston Foundation for Sight
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