Ocular Chronic Graft Versus-Host Disease after Hematopoietic Stem Cell Transplantation

Graft-versus-host disease (GVHD) is a potentially severe complication that may develop in different tissues including the eye after allogenic hematopoietic stem cell transplantation (HSCT). The purpose of this research project was to evaluate ocular surface parameters of patients undergoing HSCT before and after transplantation, and to correlate them with clinical and HSCT features. Data from the charts of ninety-three patients affected by hematological malignancies undergoing HSCT were collected. Values of Ocular Surface Disease Index, Schirmer Test type I, Tear Film Break-up Time, ocular surface staining and Meibomian Gland Dysfunction score obtained before HSCT and 3-6 months after were retrieved from charts. Diagnosis and staging of Dry Eye disease (DED) was performed according to Dry Eye WorkShop criteria. GVHD was classified according to the National Institutes of Health (NIH) 2015 Criteria. Odds ratios for DED onset after HSCT were estimated for demographic, ocular, hematological and HSCT features. Dry eye disease was diagnosed before HSCT in 50 (53%) of the patients, mostly of hyper-evaporative profile. After HSCT all ocular parameters significantly worsened with no change in DE profile. A 51% of incident cases (22 on the 43 non-DE subjects) were reported. Increasing recipient age and female sex, higher CD34+ cells infused, donor-recipient sex mismatch (males receiving from females), related donors, and peripheral blood cells as stem cell source were associated with a significant higher incidence of DED after HSCT. Systemic chronic GVHD was diagnosed in 42% while ocular GVHD in 35.5% of the patients, which decreased to 12% when taking into account only incident cases. In conclusion, a high DE prevalence was shown already before HSCT. Therefore, an ocular surface assessment should be recommended already before HSCT for early DED diagnosis and treatment. This new protocol also could influence the real prevalence of ocular GVHD after HSCT and its severity

Neurotrophic keratitis: Current challenges and future prospects

Neurotrophic keratitis (NK) is a degenerative corneal disease caused by damage of trigeminal corneal innervation, which leads to spontaneous epithelial breakdown and corneal ulceration. The impairment of corneal sensory innervation causes the reduction of both protective reflexes and trophic neuromodulators that are essential for the vitality, metabolism, and wound healing of ocular surface tissues. A wide range of ocular and systemic conditions, including herpetic keratitis, ocular chemical burns, corneal surgery, diabetes, multiple sclerosis, and neurosurgical procedures, can cause NK by damaging trigeminal innervation. Diagnosis of NK requires careful investigation of any ocular and systemic condition associated with the disease, complete ocular surface examination, and quantitative measurement of corneal sensitivity. The clinical stages of NK range from corneal epithelial alterations (stage 1) to persistent epithelial defect (stage 2) and ulcer (stage 3), which may progress to corneal perforation. Management of NK is based on clinical severity, and the aim of the therapy is to halt the progression of corneal damage and promote epithelial healing. Although several medical and surgical treatments have been proposed, no therapies are currently available to restore corneal sensitivity, and thus, NK remains difficult and challenging to treat. The purpose of this review is to summarize available evidence on the pathogenesis, diagnosis, and treatment of NK. Novel medical and surgical therapies including the topical administration of nerve growth factor and corneal neurotization are also described

Blood-Based Treatments for Severe Dry Eye Disease: The Need of a Consensus

The use of blood-based eye drops as therapy for various diseases of the ocular surface has become increasingly popular in ophthalmic practice during recent years. The rationale for their use is based on the promotion of cellular proliferation and migration thanks to the supply of metabolically active substances, in particular growth factors. Blood-derived eye drops have been used for the treatment of several ocular surface disorders, such as dry eye disease, corneal ulcer, persistent epithelial defect, neurotrophic keratitis, ocular surface burn, recurrent corneal erosion, and limbal stem-cell deficiency. Both autologous (from patients themselves) and heterologous (from adult donors or from cord blood sampled at birth)-derived products exist, and each source has specific pros and cons. Despite an extensive literature, several issues are still under debate and the aim of this manuscript is to review the indications, preparation methods and storage, characterization of content, rationale for clinical outcomes, patient stratification, length of treatment, and rationale for repeated treatments at disease relapse. A rationale based on a "5 Ws and 2 Hs" protocol is proposed as a way of thinking, with the attempt to clarify Who, Why, When, Where, What, and How to use these treatment options

Quantitative Approach for the Analysis of Fusional Convergence Using Eye-Tracking and SacLab Toolbox

Fusional vergence is a disjunctive movement of the eyes that is made in order to obtain single vision. (e aim of the study was to provide a quantitative and objective approach for analyzing the fusional convergence response using eye tracking (ET) technology and automatic data analysis provided by the intuitive SacLab toolbox previously developed by our group. We evaluated the proposed approach in a population of 26 subjects with normal binocular vision, who were tested with base-out prisms (magnitudes 4\u394, 6\u394, and 10\u394) in order to elicit fusional convergence response. Eye movements were recorded using the Viewpoint ET and analyzed using SacLab. Parameters describing both the vergence and the version components of the fusional response (convergence duration, CD; peak convergence velocity, PCV; number of intrusive saccades, NS; and mean saccadic amplitude, MSA) were automatically calculated and provided to clinicians for an objective evaluation. Results showed that the number of subjects achieving fusional convergence decreased with prism magnitude. For subjects achieving fusion CD and PCV increased significantly (p < 0.05) when increasing the prism magnitude. For NS and MSA, there were no significant changes when passing to 6\u394, but a significant increase resulted when passing to 10\u394 (p < 0.05). Noninvasive ET associated with the intuitive SacLab toolbox may represent a valid option to objectively characterize the fusional vergence response in clinical setting. (e analysis may be extended to patients with vergence disorders

No Changes in Keratometry Readings and Anterior Chamber Depth after XEN Gel Implantation in Patients with Glaucoma.

Background: This study aimed to compare keratometry and anterior chamber depth (ACD) changes after XEN implantation in primary open-angle glaucoma (POAG) cases over a 3-month follow-up period. Methods: Twenty patients with POAG who underwent XEN63 implantation, either standalone or combined with cataract surgery, were included. Preoperative data, including best-corrected visual acuity (BCVA), refraction, gonioscopy, ophthalmoscopy, intraocular pressure (IOP) evaluation, and axial length, were collected. Corneal topography and ACD measurements were assessed preoperatively and at postoperative days 1, 7, 15, 30, 60, and 90. Each patient’s eye that underwent XEN surgery was included in the study group, with the fellow eye serving as a control. Results: In the study group, there was a significant decrease in IOP after XEN stent implantation at all investigated time intervals (p < 0.05). However, changes in mean ACD did not show statistically significant differences at any follow-up examination in both the study and control groups. Additionally, keratometry readings revealed no significant changes in total astigmatism or steep keratometry values in either group. Conclusions: XEN implantation in POAG cases resulted in a significant decrease in IOP over the 3-month follow-up period. However, there were no significant changes observed in mean ACD or keratometry readings, indicating stability in these parameters post-XEN implantation. These findings suggest that XEN implantation may be an effective option for IOP reduction without affecting corneal curvature or ACD in POAG patients

Topical Treatment with Cord Blood Serum in Glaucoma Patients: A Preliminary Report

Purpose. To report data happened to be observed in two glaucoma patients treated with Cord Blood Serum (CBS) eyedrops. Design. Case report. Retrospective data analysis Methods. CBS topical eyedrops, characterized in advance for growth factors (GFs) content, were administered for two months with the aim to relieve their subjective symptoms, in two patients who had referred ocular surface discomfort, although in absence of any sign of keratopathy. As patients were also affected by advanced glaucoma at risk of vision loss, and under treatment with hypotensive drugs, they had been also monitored over the same period with IOP controls and Visual field tests in our Unit. Results. During subsequent visits, data from Mean Deviation and Pattern Standard Deviation in the Visual fields were retrospectively collected and compared before and after treatment with CBS, and an amelioration was observed. Conclusions. CBS contains a combination of GFs, which potentially exert a neuroprotective action and candidate CBS as an interesting natural source to be delivered in neurodegenerative ocular disorders. The incidentally observed amelioration in these two patients deserves further investigation in this respec

Assessment of Corneal Fluorescein Staining in Different Dry Eye Subtypes Using Digital Image Analysis

To describe a new objective technique of digital image analysis for the quantification and the morphological characterization of corneal staining in the setting of dry eye disease (DED), and to apply it to distinguish Sj\uf6gren syndrome (SS) from ocular graft versus-host disease (oGVHD)

Treatments for Ocular Diseases in Pregnancy and Breastfeeding: A Narrative Review.

Pregnancy is a medical condition in which the physiological changes in the maternal body and the potential impact on the developing fetus require a cautious approach in terms of drug administration. Individual treatment, a thorough assessment of the extent of the disease, and a broad knowledge of the therapeutic options and different routes of administration of ophthalmic drugs are essential to ensure the best possible results while minimizing risks. Although there are currently several routes of administration of drugs for the treatment of eye diseases, even with topical administration, there is a certain amount of systemic absorption that must be taken into account. Despite continuous developments and advances in ophthalmic drugs, no updated data are available on their safety profile in these contexts. The purpose of this review is both to summarize the current information on the safety of ophthalmic treatments during pregnancy and lactation and to provide a practical guide to the ophthalmologist for the treatment of eye diseases while minimizing harm to the developing fetus and addressing maternal health needs

Bilateral Corneal Perforation in a Patient with Chronic Ocular Graft-Versus-Host Disease: A Case Report and Literature Review

Graft-versus-host disease (GVHD) is a serious complication that may occur in patients receiving allogeneic hematopoietic stem cell transplant (HSCT). GVHD occurs because of the immunological reaction between the donor’s T cells and the recipient’s antigens; GVHD may develop in different tissues, including the eye. Corneal perforation is an uncommon but vision-threatening manifestation of GVHD. We reported the case of a 65-year-old male patient who developed corneal perforation sequentially in both eyes 3 years after receiving HSCT. Conservative treatment with topical steroids and lubricants, bandage contact lens, and lacrimal punctal occlusion surgery resulted in the successful resolution of the corneal perforation with satisfactory visual recovery in the right eye. Therefore, corneal perforation can occur as the presenting manifestation of ocular GVHD. Regular ophthalmological examinations are recommended after HSCT to enable the early diagnosis of ocular GVHD and prompt treatment initiation

Comparison of amsler–krumeich and sandali classifications for staging eyes with keratoconus

Keratoconus (KC) is the most common corneal ectasia characterized by progressive corneal thinning, protrusion, and irregular astigmatism. The Amsler–Krumeich classification based on the analysis of corneal topography, corneal thickness, refraction and biomicroscopy is the most commonly used; recently, a new classification based on anterior segment Optical Coherence Tomography was introduced by Sandali and colleagues. Since there is no information about the possible agreement between these two classifications, the aim of this study is to compare the stratification of consecutive KC patients using the Amsler–Krumeich and Sandali classifications, and to further ascertain KC cases in which one classification is preferred over the other. Overall, 252 eyes of 137 patients (41.45 ± 16.93 years) were analyzed: in 156 eyes (61.9%), the Amsler and Sandali staging differed in one stage while in 75 cases (29.8%) it differed in two or more stages. In 222 eyes (88.1%), the Sandali staging was higher compared to the Amsler one. These results show that the two classifications are not fully interchangeable: the Amsler–Krumeich classification is more appropriate in identifying and longitudinally monitoring patients with early stages of KC, while the Sandali classification for the diagnosis and follow-up of patients with more advanced stages, particularly when a surgical planning has to be chosen