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Treatment of Ocular Graft-Versus-Host Disease With Topical Cyclosporine 0.05%

Malta, João Baptista MD; Soong, H Kaz MD; Shtein, Roni M MD; Musch, David C PhD, MPH; Rhoades, William BS; Sugar, Alan MD; Mian, Shahzad I MD

doi: 10.1097/ICO.0b013e3181e456f0
Clinical Science

Purpose: To evaluate the efficacy of topical cyclosporine-A 0.05% (CsA) in the treatment of dry eye syndrome in ocular graft-versus-host disease after bone marrow transplantation (BMT) of hematopoietic stem cells.

Methods: One-hundred five patients were enrolled in a retrospective, comparative, interventional case series. Eighty-one patients received topical CsA starting 1 month before BMT (treatment group), and 24 patients did not receive CsA until at least 6 months after the transplantation (control group). Mean follow-up time was 17.5 ± 11.0 months (range: 6.0-49.0 months). Clinical history, ocular surface disease index questionnaire, slit-lamp examination, lissamine green and fluorescein staining of the ocular surface, tear breakup time, and Schirmer test with topical anesthesia were obtained to create a composite dry eye-grading score.

Results: Dry eye symptoms were significantly more severe in the control group at 3 months, 1 year, and 2 years (P < 0.05). There was no correlation with type of stem cell transplant (related vs. unrelated donor), presenting indication for BMT, or concurrent systemic immunosuppressive medications.

Conclusions: Pre-BMT initiation of topical CsA may reduce the inflammatory response in the lacrimal glands that may be responsible for the development of post-BMT keratitis sicca.

From the *Department of Ophthalmology and Visual Sciences, WK Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI; †Department of Ophthalmology, Division of Cornea and External Disease, Santa Casa de São Paulo, São Paulo, Brazil; and ‡Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI.

Received for publication September 26, 2009; revision received January 15, 2010; accepted February 17, 2010.

Supported in part by Fight for Sight (GA07006), Research to Prevent Blindness, and Michigan Institute for Clinical and Health Research New Pilot Clinical Trial Training Grant.

No authors have any financial or conflicting interests.

Reprints: Shahzad I. Mian, Department of Ophthalmology and Visual Sciences, WK Kellogg Eye Center, University of Michigan Medical School, 1000 Wall St, Ann Arbor, MI 48105 (e-mail:

Copyright © 2010 Wolters Kluwer Health, Inc. All rights reserved.