Incidence, Risk Factors and Complications of Ocular Graft-Versus-Host Disease Following Hematopoietic Stem Cell Transplantation

Purpose: The purpose of this research was to evaluate the incidence, risk factors and complications of ocular graft-versus-host disease (GVHD) in a large single center study. Design: Retrospective observational case series. Methods: This study included 283 patients who underwent hematopoietic stem cell transplantation (HSCT) between 2005 and 2020. Ocular GVHD was diagnosed according to the International Chronic Ocular GVHD Consensus Group criteria. Potential risk factors for ocular GVHD were evaluated using the Cox proportional hazards model. Results: The cumulative incidence of ocular GVHD was 19.7% at 1 year, 29.3% at 2 years, 40.7% at 3 years, 47.2% at 4 years and 49.7% at 5 years. Ocular GVHD was significantly associated with recipient age (HR, 1.228; 95% CI, 1.033-1.459; P = 0.020), female recipients (HR, 1.797; 95% CI, 1.195-2.703; P = 0.005), peripheral blood stem cell use (PBSC) (HR, 2.079; 95% CI, 1.268-3.411; P = 0.004), and previous acute GVHD (HR, 1.276; 95% CI, 1.073-1.518; P = 0.006). The ocular complications after HSCT included cataract, corneal ulcer, corneal perforation, lacrimal obstruction, herpetic keratitis and cytomegalovirus retinitis. Conclusions: Half of patients developed ocular GVHD in the five years following HSCT. Older age, female sex, use of PBSC and acute GVHD disease were significant predictors of ocular GVHD. Hematologists and ophthalmologists should be aware of its vision threating complications.