Bilateral corneal ulceration in ocular graft-versus-host disease

William Stevenson, Hasanain Shikari, Ujwala S Saboo, Francisco Amparo, Reza Dana Cornea Service, Massachusetts Eye and Ear Infirmary, Boston, MA, USA Purpose: To report on corneal ulceration in ocular graft-versus-host disease (GVHD). Methods: This was a retrospective, observational case series investigating corneal ulceration and perforation in a cohort of ocular GVHD patients seen between June 2007 and October 2012. Results: Four of 243 ocular GVHD patients developed corneal ulcerations attributable to ocular GVHD, and all four cases involved bilateral corneal ulceration. The median length of time from the diagnosis of ocular GVHD to the diagnosis of the first corneal ulceration was 317 days (range 168–434). The median length of time between the diagnosis of corneal ulceration in each patient's first and second eye was 248 days (range 9–645). Outcomes varied from complete resolution with medical treatment to corneal perforation necessitating penetrating keratoplasty. In cases of corneal perforation, the median length of time from the diagnosis of corneal ulceration to perforation was 10 days (range 0–20). Common clinical features included: centrally or paracentrally located ulcerations and perforations, concomitant dry eye, and the use of topical or systemic corticosteroids. Conclusion: Frequent follow-up and bilateral monitoring are highly recommended in cases of ocular GVHD-associated stromal thinning, as bilateral involvement or rapid progression to corneal perforation can occur. Keywords: graft-versus-host disease, ocular graft-versus-host disease, corneal ulceration, corneal perforatio

Health‐related quality of life in children at the diagnosis of Vernal Keratoconjunctivitis

BACKGROUND: Vernal keratoconjunctivitis (VKC) is a bilateral, chronic, allergic condition mostly affecting children. Clinical evaluations may not necessarily reflect the impact of the disease on the patients' health-related quality of life (HRQoL). We aimed to evaluate HRQoL in children at VKC diagnosis and to analyze correlations between HRQoL and clinical and laboratory variables.METHODS: We studied 5 to12 years old patients with VKC. Data on clinical history, instrumental eye evaluations, blood exams and Visual analogue scale (VAS) for the subjective symptoms were collected. HRQoL was assessed through a disease-specific validated Quality of Life in Children with Vernal Keratoconjunctivitis (QUICK) Questionnaire.RESULTS: Seventy subjects were included in the analysis (Female/Male: 10/60; Tarsal/mixed VKC form: 36/34). Clinical severity of VKC according with Bonini scale was: 14 mild, 36 moderate and 20 severe. No significant difference was found concerning distribution of patient age, gender, history of allergic manifestations between tarsal and mixed VKC. A significant positive correlation was found between all QUICK scores and VAS scores, including different VAS subscale, while no significant correlation was found between QUICK scores and total signs scores, Schirmer test, and corneal thickness. The presence of active severe VKC was not associated with worse HRQoL.CONCLUSIONS: Our evidence shows that VKC patients experience impairment of HRQoL, especially in relation to the perception of symptoms independently of the ophthalmological changes found, and that QUICK questionnaire could be a useful tool to evaluate HRQoL in children with VKC which may improve patients' classification and management