The eye in bone marrow transplantation. III. Conjunctival graft-vs-host disease
D. A. Jabs, J. Wingard, W. R. Green, E. R. Farmer, G. Vogelsang and R. Saral
Department of Ophthalmology, Johns Hopkins Oncology Center, Johns Hopkins University School of Medicine, Baltimore, Md.
Of a series of 263 patients undergoing allogeneic bone marrow
transplantation (BMT), 24 patients developed conjunctival involvement by
graft-vs-host disease (GVHD). In each case, a distinct-appearing
conjunctivitis developed that representing GVHD of the conjunctiva. In 19
cases (79%), conjunctival GVHD presented with pseudomembrane formation due
to loss of the conjunctival epithelium; in 4 of these cases, the corneal
epithelium was lost as well. Nineteen patients developed this feature in
association with acute GVHD, and mortality among these patients was 89.5%.
Kaplan-Meier analysis of survival demonstrated a decreased survival of
patients with conjunctival involvement compared with all marrow transplant
recipients and compared with all patients with GVHD. However, survival was
similar to that seen in patients with severe systemic GVHD (overall stages
II through IV). Five patients developed conjunctival GVHD in association
with chronic GVHD, and all had severe chronic GVHD. four of these five with
chronic GVHD subsequently died. Conjunctival involvement by GVHD represents
a distinct clinical finding and is a marker for severe systemic involvement
by GVHD. A clinical staging system for ocular involvement was formulated.
