慢性眼部移植物抗宿主病相关干眼的研究与治疗现状

异基因造血干细胞移植(allo-HSCT)是治疗多种血液系统恶性肿瘤的主要方法,但术后的慢性移植物抗宿主病(cGVHD)是一种常见的并发症,其中眼部移植物抗宿主病(oGVHD)是最常见的一种,主要累及泪腺、睑板腺、角膜和结膜,典型症状为以纤维化为特征的干眼综合征。oGVHD相关干眼导致患者生活质量显著下降,已引起广泛关注。oGVHD的治疗除了应用全身免疫抑制剂和眼润滑剂外,通常联合局部使用糖皮质激素和环孢素。对于中重度oGVHD较新的治疗措施还包括使用自体血清滴眼液和角巩膜接触镜。本文主要就oGVHD及其相关干眼的治疗现状进行综述,以期为临床诊疗提供思路。     

慢性移植物抗宿主病干眼相关生物标志物

异基因造血干细胞移植术(allo-HSCT)是治疗血液系统恶性及非恶性疾病常见的治疗方法,而allo-HSCT后常见慢性移植物抗宿主病(cGVHD)干眼等眼部并发症,严重影响患者的生存质量,严重者可能会导致角膜穿孔甚至盲。随着allo-HSCT技术不断成熟,移植人数逐渐增多、移植后患者生存时间延长,cGVHD干眼的发生...     

慢性移植物抗宿主病相关干眼纤维化发病机制研究进展

慢性移植物抗宿主病(cGVHD)是异基因造血干细胞移植(allo-HSCT)后的一个主要并发症,类似于自身免疫性疾病,累及全身多个器官。干眼是cGVHD眼部的主要表现,严重影响患者的生活质量。研究发现,慢性炎症和纤维化是cGVHD相关干眼患者眼部多个组织的主要病理生理表现。目前关于cGVHD相关干眼纤维化的发病机制尚不清楚,因此本文从成纤维细胞、免疫细胞、促纤维化细胞因子、肾素-血管紧张素系统和内质网应激方面对cGVHD相关干眼纤维化机制进行综述,以期能针对纤维化研发出新的诊断、治疗和预防策略。     

慢性移植物抗宿主病相关干眼1例报告

目的总结慢性移植物抗宿主病相关干眼的诊治经验。方法回顾性分析1例接受异体骨髓造血干细胞移植术后干眼病例的临床资料。结果患者异体骨髓造血干细胞移植术后3年双眼出现严重的干眼表现,通过局部使用绷带镜及激素、免疫抑制剂、人工泪液等点眼治疗后干眼症状好转但治疗过程发生了急性结膜炎,故停止使用绷带镜、加强抗感染治疗后好转。结论慢性移植物抗宿主病相关干眼是异体骨髓造血干细胞移植术后最多见的眼部表现,与患者生存质量密切相关。认识此病的危害性,早期及时诊治具有重要意义。     

慢性移植物抗宿主病相关性干眼的研究进展

慢性移植物抗宿主病(chronic graft-versus-host disease,cGVHD)是骨髓移植后最具有破坏性并发症之一。移植物抗宿主病(graft-versus-host disease,GVHD)发生在10%～80%的造血干细胞移植(hematopoietic stem cell transplantation)受者中,而眼睛是人身体最脆弱的器官之一,有40%～60%接受HSCT的患者发生眼部GVHD,它主要影响泪腺、睑板腺、角膜和结膜等。cGVHD相关性干眼(dry eye associated with chronic graft-versus-host disease,cGVHD-DE)是眼部GVHD最多见的表现形式。cGVHD-DE的长期治疗因涉及多学科、多重结合治疗,至今仍然具有挑战性,其除了全身免疫抑制和眼部润滑剂外,通常还使用局部类固醇、环孢霉素和他克莫司滴眼液。针对中度和重度cGVHD-DE的治疗干预包括使用自体血清滴眼液和佩戴巩膜镜等,新兴起的治疗方案包括重链透明质酸(heavy chain-hvaluronan)/穿透素(pentraxin 3)结...     

慢性移植物抗宿主病的重度干眼和局部FK506治疗

干眼症是造血干细胞移植后慢性移植物抗宿主病(chroicgraftversushostdisease,cGVHD)的表现之一 ,虽不威胁生命却严重影响生活质量〔1～ 3〕。国内尚未见报告 ,眼科医生对其认识较少且治疗棘手 ,现将异基因外周血干细胞移植术后严重干眼及局部FK5 0 6治疗初步观察报告如下。例 1　男　 37岁　急性髓性白血病。 2 0 0 1年 4月 10日行异基因外周血干细胞移植术。术后 4 4天出现皮肤丘疹样皮疹、角化 ,口唇粘膜苍白。术后 116天出现双眼红、畏光、干燥伴口干。眼科检查 :双眼视力均为 0 1(矫正 :右 1 0 ;左 0 9) ,睑球结膜充血明显 ,角结…     

个体化综合治疗慢性移植物抗宿主病相关干眼的临床研究

目的 观察个体化综合治疗慢性移植物抗宿主病相关干眼的临床效果.方法 回顾性分析2013年3月至2016年11月在我院诊治的造血干细胞移植术后慢性移植物抗宿主病相关干眼患者19例(38眼),根据病情不同个体化地给予人工泪液、小牛血去蛋白提取物眼用凝胶、成纤维细胞生长因子眼用凝胶及lg·Ll氟米龙滴眼液等不同组合的复合用药方案进行综合治疗.治疗前后行裂隙灯检查、干眼症状评分、视力、角膜荧光素染色(fluorescent staining,FS)、泪膜破裂时间(break-up time, BUT)、基础泪液分泌试验(Schimer I test,SIT)等检查,观察治疗前及治疗2个月后干眼症状及体征的变化.结果 治疗前干眼症状评分项目中干涩感、异物感、烧灼感、疼痛、眼红分别为(2.72±0.78)分、(2.58±0.89)分、(2.46±0.64)分、(2.27±0.54)分、(2.54±0.66)分,治疗后均较治疗前有不同程度的改善,各症状评分分别为(1.68±0.82)分、(1.62±0.72)分、(1.57±0.59)分、(1.44±0.62)分、(2.09±0.58)分(均为P＜0.05);眼部视疲劳、畏光评分较治疗前略有改善,但差异均无统计学意义(均为P＞0.05);治疗后视力有所提高,差异有统计学意义;角膜FS评分由治疗前的(8.6±2.4)分减少为治疗后的(2.2±1.6)分,差异有统计学意义(P =0.000);BUT略有增加,SIT略有下降,但两者治疗前后的差异均无统计学意义(均为P＞0.05).结论 个体化地给予人工泪液、小牛血去蛋白提取物眼用凝胶、成纤维细胞生长因子眼用凝胶及lg·L-1氟米龙滴眼液等综合治疗能改善造血干细胞移植术后慢性移植物抗宿主病相关干眼症状和部分体征,提高视觉质量.     

慢性眼部移植物抗宿主病治疗的研究进展

眼部移植物抗宿主病发生在超过一半的慢性移植物抗宿主病患者中,涉及眼表持续的炎症以及纤维化改变,最常见的表现为干燥性角膜结膜炎。严重的眼部移植物抗宿主病不但影响患者的工作和生活质量,同时也增加了其他眼部并发症的风险。慢性眼部移植物抗宿主病的治疗主要包括局部应用人工泪液、血清类制剂、抗炎药物等药物治疗,佩戴隐形眼镜、睑板腺按摩等物理治疗、封闭泪点、重建眼表等手术治疗。随着对眼部移植物抗宿主病发病机制的深入研究,许多新的治疗药物和治疗手段涌现临床。总结目前慢性眼部移植物抗宿主病在药物治疗、物理治疗、手术治疗方面的最新研究进展,将有助于为慢性眼部移植物抗宿主病的治疗带来更多选择和更新的研究思路。     

移植物抗宿主病相关的干眼病

目的 观察异基因造血干细胞移植术后移植物抗宿主病的眼部表现。方法 对20例异基因造血干细胞移植术后白血病患者的随访结果进行回顾性研究,随访的主要眼科检查项目包括视力、裂隙灯显微镜、荧光素染色、虎红染色、泪膜破裂时间、Schirmer Ⅰ和SchirmerⅡ试验,部分患者行共焦显微镜检查、结膜印迹细胞检查和病理活检。结果 术后14例患者出现移植物抗宿主病。8例出现干眼病,占移植物抗宿主病患者的57％。其中4例为严重干眼病,患者伴有视力明显下降,甚至角膜溃疡;病理检查结果示：结膜杯状细胞消失或明显减少,结膜上皮角化,角膜上皮鳞状化生,结膜炎性反应细胞以T淋巴细胞为主。结论 于眼病是慢性移植物抗宿主病的主要眼部合并症,严重影响患者生活质量,应引起足够重视。     

泪小管塞栓治疗重度慢性眼移植物抗宿主病的安全性和有效性

目的:评估泪小管塞栓治疗重度慢性眼移植物抗宿主病(coGVHD)的安全性和有效性。方法:回顾性研究。纳入2022-06/09就诊于徐州医科大学附属医院干眼门诊的重度coGVHD患者9例,均行双眼下泪小管塞栓术。观察术前、术后1、3mo眼表疾病指数(OSDI)评分、泪河高度(TMH)、角膜荧光素染色评分(CFS)、结膜丽丝胺绿染色评分(CLGS)、非接触式泪膜破裂时间(NIBUT)、SchirmerⅠ试验(SⅠt)和使用共聚焦角膜显微镜检测角膜浅基质层浸润的朗格汉斯细胞密度,记录并发症发生情况。结果:术后3mo,患者OSDI评分为21.89±6.07分,较术前(67.33±12.64分)下降(P<0.01);TMH术后3mo为0.21±0.03mm较术前0.09±0.02mm上升(P<0.05);NIBUT术后3mo为6.77±2.05s较术前2.24±0.68s上升(P<0.01)。CFS和CLGS术后3mo为2.22±0.67、2.56±0.88分较术前(9.11±1.45、6.33±1.00分)下降(均P<0.01)。朗格汉斯细胞密度术后3mo为39.67±...     

慢性移植物抗宿主病的干眼症的研究新进展

干眼症是造血干细胞移植后慢性移植物抗宿主病的表现之一,关于它的发病机制目前流行的假说为T淋巴细胞免疫激活泪腺组织的成纤维细胞,使泪腺组织纤维化,严重影响泪腺的分泌功能。干眼症虽不危及生命却严重影响生活质量。目前有效治疗慢性移植物抗宿主病的干眼症的药物有自体血清眼药水、环孢霉素A、FK506等。     

Efficacy of topical cyclosporine 0.05% in the treatment of dry eye associated with graft versus host disease

PURPOSE: To assess the efficacy of topical cyclosporine 0.05% (Restasis) in patients with dry eye associated with graft versus host disease after stem cell transplantation. METHODS: After completing a 3-month run-in period of using only artificial tears to control dry eye symptoms in both eyes, patients who failed to achieve adequate relief (n = 8) were instructed to instill topical cyclosporine twice a day. Visual acuity, slit-lamp appearance, and intraocular pressure were evaluated every 2 weeks for a minimum of 3 months. In addition, Schirmer basal secretion tests, noninvasive fluorescein breakup time, and tear lysozyme were also performed. Patients were also given a dry eye questionnaire regarding symptoms of burning, tearing, and blurred vision. RESULTS: Dry eye signs improved significantly with cyclosporine treatment in 7 of 8 patients. Cyclosporine provided statistically significant improvements in Schirmer basal secretion scores (P = 0.003), tear breakup time (P = 0.002), and tear lysozyme levels (P = 0.033) after 3 months of treatment. CONCLUSION: The findings in this prospective study suggest that dry eye associated with graft versus host disease can be effectively treated with topical cyclosporine, especially in patients unresponsive to other treatment modalities. These findings should be further evaluated in large-scale, controlled clinical trials.     

Update on ocular graft versus host disease

PURPOSE OF REVIEW: To summarize recent findings regarding the clinical spectrum, pathophysiology, and treatment of ocular graft versus host disease. RECENT FINDINGS: Ocular graft versus host disease is a common sequela of allogeneic hematopoietic transplantation affecting up to 80% of chronic graft versus host disease patients. Clinical features of ocular graft versus host disease encompass all parts of the eye, from the lid to the choroids, although ocular graft versus host disease is most commonly viewed as a disease of the ocular surface, with the conjunctiva and lacrimal gland most commonly affected. Clinical features of ocular graft versus host disease (keratoconjunctivitis sicca, cicatricial conjunctivitis, scleritis, and others) mirror other inflammatory ocular conditions associated with autoimmune/collagen vascular diseases. Immunohistochemistry studies of lacrimal gland dysfunction and conjunctival inflammation in chronic ocular graft versus host disease are summarized. Current diagnosis and treatment of chronic graft versus host disease are outlined in the recent publications from the National Institute of Health Chronic graft versus host disease Consensus Workshops, and the information relevant to ocular graft versus host disease is delineated. SUMMARY: Ocular graft versus host disease evaluation, diagnosis, and management should be approached in a multidisciplinary fashion in the context of the patient's overall graft versus host disease status.     

Ocular manifestations of graft versus host disease

PURPOSE OF REVIEW: A review of the current literature regarding the ocular manifestations and management of graft versus host disease is presented. RECENT FINDINGS: A variety of systemic and topical anti-inflammatory or immunomodulatory agents, including prednisolone acetate, cyclosporine A, FK506, autologous serum, and retinoic acid show promise in controlling ocular graft versus host disease. SUMMARY: Graft versus host disease is a common manifestation of allogeneic stem cell transplantation. Ocular manifestations are found in a majority of patients and may be the presenting symptom. Ocular findings include keratoconjunctivitis sicca, pseudomembranous conjunctivitis, corneal ulceration and perforation, and microvascular retinopathy. Systemic and local therapy may be used to control ocular disease.     

Ocular manifestations of graft versus host disease following bone marrow transplantation

The ocular manifestations of Graft Versus Host Disease (GVHD) include keratoconjunctivitis sicca, cicatricial lagophthalmos, sterile conjunctivitis, corneal epithelial defects, corneal ulceration and melting. These manifestations are more frequent in patients with chronic GVHD than in patients with acute GVHD. The more severe ocular complications are associated with severe systemic chronic GVHD and poorer survival. Recent improvements in the systemic management of these patients have led to the more frequent recognition of the ocular problems. The high prevalence of ocular involvement and potentially severe ocular problems in GVHD patients necessitate close ophthalmic monitoring.