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Topical cyclosporine A mitigates dry eye associated with graft-versus-host disease
Cornea. 2010;29(12):1392-1396.
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Topical cyclosporine A showed potential to reduce dry eye syndrome associated with graft-versus-host disease after bone marrow transplantation of hematopoietic stem cells, a study found.
Dry eye syndrome is the most common ocular manifestation of graft-versus-host disease.
"Ocular [graft-versus-host disease] often presents 6 months or more after [bone marrow transplantation]," the study authors said. "Therefore, the referral of patients to an ophthalmologist before the development of ocular symptoms may permit early intervention and ensuing reduction of the ocular surface damage."
The retrospective study included 162 eyes of 81 patients who began receiving Restasis (topical cyclosporine A 0.05%, Allergan) twice daily in both eyes 1 month before transplantation. A comparator group comprised 48 eyes of 24 patients who commenced cyclosporine A at least 6 months after transplantation.
Investigators assessed ocular surface staining, tear break-up time and Schirmer testing to compute composite dry eye grading scores. Mean follow-up was 17.5 months.
Study results showed that the control group had significantly more severe dry eye symptoms than the treatment group at 3 months and 2 years (P = .04 and P = .03, respectively).
The treatment group had significantly higher Schirmer scores than controls at 1 year. Tear break-up time was shorter than 10 seconds in 90.6% of patients in the treatment group and 42.9% of controls at 1 year (P = .01).
Graft-versus-host disease is an extremely common complication of bone marrow transplantation and is essentially a laboratory that verifies the importance of T-cell lymphocytes in the pathogenesis of dry eye disease. Since over 50% of patients who receive bone marrow transplants develop dry eye disease, the authors have elected to study pretreating these patients with commercially available cyclosporine A 0.05% (Restasis). Their results show an overwhelming improvement in dry eye signs and symptoms in the patients who were pretreated with cyclosporine. This paper establishes the efficacy of prophylaxis with topical cyclosporine against dry eye disease in patients undergoing bone marrow transplantation. In addition, this paper is important in that it suggests that other high-risk patients might benefit from early treatment to prevent progression of their dry eye disease.
– Eric D. Donnenfeld, MD
OSN
Cornea/External Disease Board Member
Disclosure: Dr. Donnenfeld is a paid
consultant or Allergan.