Challenges and concepts in the diagnosis and management of ocular graft-versus-host disease
Graft-versus-host disease (GVHD) is characterized by tissue inflammation in the host following an allogeneic hematopoietic cell transplantation (HCT). The pathophysiology is complex and only incompletely understood yet. Donor lymphocyte interaction with the histocompatibility antigens of the host pl...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-02-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2023.1133381/full |
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| author | Christoph Tappeiner Christoph Tappeiner Christoph Tappeiner Christoph Tappeiner Arnd Heiligenhaus Joerg P. Halter Elisabetta Miserocchi Francesco Bandello David Goldblum David Goldblum |
| author_facet | Christoph Tappeiner Christoph Tappeiner Christoph Tappeiner Christoph Tappeiner Arnd Heiligenhaus Joerg P. Halter Elisabetta Miserocchi Francesco Bandello David Goldblum David Goldblum |
| author_sort | Christoph Tappeiner |
| collection | DOAJ |
| description | Graft-versus-host disease (GVHD) is characterized by tissue inflammation in the host following an allogeneic hematopoietic cell transplantation (HCT). The pathophysiology is complex and only incompletely understood yet. Donor lymphocyte interaction with the histocompatibility antigens of the host plays a crucial role in the pathogenesis of the disease. Inflammation may affect multiple organs and tissues, e.g., the gastrointestinal tract, liver, lung, fasciae, vaginal mucosa, and the eye. Subsequently, alloreactive donor-derived T and B lymphocytes may lead to severe inflammation of the ocular surface (i.e., cornea and conjunctiva) and the eyelids. Furthermore, fibrosis of the lacrimal gland may lead to severe dry eye. This review focuses on ocular GVHD (oGVHD) and provides an overview of current challenges and concepts in the diagnosis and management of oGVHD. Ophthalmic manifestations, diagnostic procedures, grading of severity and recommendations for ophthalmic examination intervals are provided. Management of ocular surface disease with lubricants, autologous serum eye drops, topical anti-inflammatory agents and systemic treatment options are described based on the current evidence. Ocular surface scarring and corneal perforation are severe complications of oGVHD. Therefore, ophthalmic screening and interdisciplinary treatment approaches are highly relevant to improve the quality of life of patients and to prevent potentially irreversible visual loss. |
| first_indexed | 2024-04-10T09:19:32Z |
| format | Article |
| id | doaj.art-33beb605a3484ec3b0e804d494bf657d |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-04-10T09:19:32Z |
| publishDate | 2023-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-33beb605a3484ec3b0e804d494bf657d2023-02-20T14:06:37ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2023-02-011010.3389/fmed.2023.11333811133381Challenges and concepts in the diagnosis and management of ocular graft-versus-host diseaseChristoph Tappeiner0Christoph Tappeiner1Christoph Tappeiner2Christoph Tappeiner3Arnd Heiligenhaus4Joerg P. Halter5Elisabetta Miserocchi6Francesco Bandello7David Goldblum8David Goldblum9Department of Ophthalmology, Pallas Klinik, Olten, SwitzerlandDepartment of Ophthalmology, University Hospital Essen, University Duisburg-Essen, Essen, GermanyDepartment of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute, Milan, ItalyFaculty of Medicine, University of Bern, Bern, SwitzerlandDepartment of Ophthalmology at St. Franziskus Hospital, Muenster, GermanyDepartment of Hematology, University Hospital Basel, University of Basel, Basel, SwitzerlandDepartment of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute, Milan, ItalyDepartment of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute, Milan, ItalyDepartment of Ophthalmology, Pallas Klinik, Olten, SwitzerlandFaculty of Medicine, University of Basel, Basel, SwitzerlandGraft-versus-host disease (GVHD) is characterized by tissue inflammation in the host following an allogeneic hematopoietic cell transplantation (HCT). The pathophysiology is complex and only incompletely understood yet. Donor lymphocyte interaction with the histocompatibility antigens of the host plays a crucial role in the pathogenesis of the disease. Inflammation may affect multiple organs and tissues, e.g., the gastrointestinal tract, liver, lung, fasciae, vaginal mucosa, and the eye. Subsequently, alloreactive donor-derived T and B lymphocytes may lead to severe inflammation of the ocular surface (i.e., cornea and conjunctiva) and the eyelids. Furthermore, fibrosis of the lacrimal gland may lead to severe dry eye. This review focuses on ocular GVHD (oGVHD) and provides an overview of current challenges and concepts in the diagnosis and management of oGVHD. Ophthalmic manifestations, diagnostic procedures, grading of severity and recommendations for ophthalmic examination intervals are provided. Management of ocular surface disease with lubricants, autologous serum eye drops, topical anti-inflammatory agents and systemic treatment options are described based on the current evidence. Ocular surface scarring and corneal perforation are severe complications of oGVHD. Therefore, ophthalmic screening and interdisciplinary treatment approaches are highly relevant to improve the quality of life of patients and to prevent potentially irreversible visual loss.https://www.frontiersin.org/articles/10.3389/fmed.2023.1133381/fullocular graft-versus-host disease (GVHD)dry eyeocular surface inflammationdiagnosistreatment |
| spellingShingle | Christoph Tappeiner Christoph Tappeiner Christoph Tappeiner Christoph Tappeiner Arnd Heiligenhaus Joerg P. Halter Elisabetta Miserocchi Francesco Bandello David Goldblum David Goldblum Challenges and concepts in the diagnosis and management of ocular graft-versus-host disease Frontiers in Medicine ocular graft-versus-host disease (GVHD) dry eye ocular surface inflammation diagnosis treatment |
| title | Challenges and concepts in the diagnosis and management of ocular graft-versus-host disease |
| title_full | Challenges and concepts in the diagnosis and management of ocular graft-versus-host disease |
| title_fullStr | Challenges and concepts in the diagnosis and management of ocular graft-versus-host disease |
| title_full_unstemmed | Challenges and concepts in the diagnosis and management of ocular graft-versus-host disease |
| title_short | Challenges and concepts in the diagnosis and management of ocular graft-versus-host disease |
| title_sort | challenges and concepts in the diagnosis and management of ocular graft versus host disease |
| topic | ocular graft-versus-host disease (GVHD) dry eye ocular surface inflammation diagnosis treatment |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2023.1133381/full |
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