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Ocul Surf. 2016 Jul;14(3):393-400. doi: 10.1016/j.jtos.2016.04.003. Epub 2016 May 12.

Superior Limbic Keratoconjunctivitis-like Inflammation in Patients with Chronic Graft-Versus-Host Disease.

Author information

1
Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL.
2
Loyola University, Department of Ophthalmology, Maywood, IL.
3
BostonSight®, Needham Heights, MA; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
4
Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL. Electronic address: adjalili@uic.edu.

Abstract

PURPOSE:

Describe the presentation and management of superior limbic keratoconjunctivitis (SLK)-like inflammation and secondary limbal stem cell dysfunction in the setting of ocular chronic graft-versus-host disease (cGVHD).

METHODS:

Retrospective observational case series in a multicenter clinical practice. Participants were 13 patients (26 eyes) with ocular cGVHD and SLK-like inflammation presenting to the University of Illinois at Chicago and BostonSight® between January 1, 2009 and July 1, 2013.

MAIN OUTCOME MEASURES:

1) Reversal or worsening of SLK, and 2) development of limbal stem cell dysfunction.

RESULTS:

All eyes showed evidence of SLK-like inflammation and superior limbal stem cell dysfunction manifested by conjunctival injection and superior conjunctival and corneal staining. In addition to aggressive lubrication, management strategies for SLK included topical steroids (20/26), punctal occlusion (18/26), topical cyclosporine (24/26), autologous serum tears (12/26), therapeutic soft contact lens (13/26 eyes) and scleral lenses (4/26 eyes). SLK and limbal stem cell dysfunction were reversed in 23/26 eyes. Three eyes of two patients with long-standing disease demonstrated frank limbal stem cell deficiency (LSCD) and corneal pannus, with one patient requiring multiple reconstructive surgical procedures.

CONCLUSIONS:

SLK-like inflammation is an under-recognized condition in patients with severe dry eyes secondary to ocular cGVHD. Untreated SLK can potentially lead to permanent LSCD over time. Early recognition and management of SLK in ocular cGVHD can improve vision, reverse signs, and may prevent these long-term consequences.

KEYWORDS:

Limbal stem cell dysfunction; ocular chronic graft-versus-host disease; prosthetic replacement of the ocular surface (PROSE); superior limbic keratoconjunctivitis

PMID:
27179980
PMCID:
PMC5554073
DOI:
10.1016/j.jtos.2016.04.003
[Indexed for MEDLINE]
Free PMC Article

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