[Corneal ulcer in chronic graft-versus-host disease: treatment with collagen shields].

Abstract

BACKGROUND:

After bone marrow transplantation various ocular diseases have been described. Ocular involvement is very common in patients with chronic Graft-versus-Host Disease (GvHD). These patients show clinical and histological evidence of a dry-eye condition in 60-100 per cent. A severe complication is the development of a corneal ulcer with possible corneal perforation. Two patients with a severe dry-eye condition and development of corneal stroma ulceration are described. The corneal ulcers healed after treatment with collagen-shield.

HISTORY AND SIGNS:

In a 13-year-old boy an allogeneic bone marrow transplantation was performed in April 1989 because of Fanconi's anemia. In November 1989 a severe dry-eye condition occurred due to GvHD with skin, liver, and gastrointestinal tract manifestation. In April 1991 he presented with corneal stroma ulceration of the right eye. In a 24-year-old patient an allogeneic bone marrow transplantation was performed because of chronic myeloid leukemia in August 1989. In December 1989 he developed dry-eye condition due to GvHD with skin, mucosa and liver involvement. In December 1991 a corneal ulcer of the left eye occurred.

THERAPY AND OUTCOME:

Repeated conjunctival and corneal smears were negative. Local antibiotic and antiviral treatment showed no effect. Corneal ulcers deteriorated progressively with corneal thinning. Both patients were therefore treated with daily collagen-shields and hourly polyvinyl-pyrrolidon eye-drops resulting in healing of the corneal ulcer within 3 and 2 weeks respectively.

CONCLUSION:

Treatment of corneal stromal ulceration in dry eye condition caused by chronic GvHD is difficult. In noninfectious ulcers daily application of collagen-shields and hourly artificial tears may prevent severe ocular complications like corneal perforation.

• Authors: C W Spraul, G E Lang, G K Lang
• Journal: Klinische Monatsblatter fur Augenheilkunde (Klin Monbl Augenheilkd) Vol. 205 Issue 3 Pg. 161-6 (Sep 1994) ISSN: 0023-2165 [Print] Germany
• Vernacular Title: Hornhautulzerationen bei chronischer Graft-versus-Host Disease (GvHD): Behandlung durch Collagen-Shields.
• PMID: 7996821 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Ophthalmic Solutions
• Collagen
• Povidone

Topics

• Adolescent
• Adult
• Bone Marrow Transplantation
• Collagen
• Corneal Ulcer (therapy)
• Dry Eye Syndromes (therapy)
• Fanconi Anemia (therapy)
• Graft vs Host Disease (therapy)
• Humans
• Leukemia, Myelogenous, Chronic, BCR-ABL Positive (therapy)
• Male
• Ophthalmic Solutions
• Povidone (administration & dosage)
• Tears (metabolism)