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Challenges and concepts in the diagnosis and management of ocular graft-versus-host disease

Graft-versus-host disease (GVHD) is characterized by tissue inflammation in the host following an allogeneic hematopoietic cell transplantation (HCT). The pathophysiology is complex and only incompletely understood yet. Donor lymphocyte interaction with the histocompatibility antigens of the host pl...

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Autores principales: Tappeiner, Christoph, Heiligenhaus, Arnd, Halter, Joerg P., Miserocchi, Elisabetta, Bandello, Francesco, Goldblum, David
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9987249/
https://www.ncbi.nlm.nih.gov/pubmed/36891189
http://dx.doi.org/10.3389/fmed.2023.1133381
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author Tappeiner, Christoph
Heiligenhaus, Arnd
Halter, Joerg P.
Miserocchi, Elisabetta
Bandello, Francesco
Goldblum, David
author_facet Tappeiner, Christoph
Heiligenhaus, Arnd
Halter, Joerg P.
Miserocchi, Elisabetta
Bandello, Francesco
Goldblum, David
author_sort Tappeiner, Christoph
collection PubMed
description Graft-versus-host disease (GVHD) is characterized by tissue inflammation in the host following an allogeneic hematopoietic cell transplantation (HCT). The pathophysiology is complex and only incompletely understood yet. Donor lymphocyte interaction with the histocompatibility antigens of the host plays a crucial role in the pathogenesis of the disease. Inflammation may affect multiple organs and tissues, e.g., the gastrointestinal tract, liver, lung, fasciae, vaginal mucosa, and the eye. Subsequently, alloreactive donor-derived T and B lymphocytes may lead to severe inflammation of the ocular surface (i.e., cornea and conjunctiva) and the eyelids. Furthermore, fibrosis of the lacrimal gland may lead to severe dry eye. This review focuses on ocular GVHD (oGVHD) and provides an overview of current challenges and concepts in the diagnosis and management of oGVHD. Ophthalmic manifestations, diagnostic procedures, grading of severity and recommendations for ophthalmic examination intervals are provided. Management of ocular surface disease with lubricants, autologous serum eye drops, topical anti-inflammatory agents and systemic treatment options are described based on the current evidence. Ocular surface scarring and corneal perforation are severe complications of oGVHD. Therefore, ophthalmic screening and interdisciplinary treatment approaches are highly relevant to improve the quality of life of patients and to prevent potentially irreversible visual loss.
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spelling pubmed-99872492023-03-07 Challenges and concepts in the diagnosis and management of ocular graft-versus-host disease Tappeiner, Christoph Heiligenhaus, Arnd Halter, Joerg P. Miserocchi, Elisabetta Bandello, Francesco Goldblum, David Front Med (Lausanne) Medicine Graft-versus-host disease (GVHD) is characterized by tissue inflammation in the host following an allogeneic hematopoietic cell transplantation (HCT). The pathophysiology is complex and only incompletely understood yet. Donor lymphocyte interaction with the histocompatibility antigens of the host plays a crucial role in the pathogenesis of the disease. Inflammation may affect multiple organs and tissues, e.g., the gastrointestinal tract, liver, lung, fasciae, vaginal mucosa, and the eye. Subsequently, alloreactive donor-derived T and B lymphocytes may lead to severe inflammation of the ocular surface (i.e., cornea and conjunctiva) and the eyelids. Furthermore, fibrosis of the lacrimal gland may lead to severe dry eye. This review focuses on ocular GVHD (oGVHD) and provides an overview of current challenges and concepts in the diagnosis and management of oGVHD. Ophthalmic manifestations, diagnostic procedures, grading of severity and recommendations for ophthalmic examination intervals are provided. Management of ocular surface disease with lubricants, autologous serum eye drops, topical anti-inflammatory agents and systemic treatment options are described based on the current evidence. Ocular surface scarring and corneal perforation are severe complications of oGVHD. Therefore, ophthalmic screening and interdisciplinary treatment approaches are highly relevant to improve the quality of life of patients and to prevent potentially irreversible visual loss. Frontiers Media S.A. 2023-02-16 /pmc/articles/PMC9987249/ /pubmed/36891189 http://dx.doi.org/10.3389/fmed.2023.1133381 Text en Copyright © 2023 Tappeiner, Heiligenhaus, Halter, Miserocchi, Bandello and Goldblum. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Tappeiner, Christoph
Heiligenhaus, Arnd
Halter, Joerg P.
Miserocchi, Elisabetta
Bandello, Francesco
Goldblum, David
Challenges and concepts in the diagnosis and management of ocular graft-versus-host disease
title Challenges and concepts in the diagnosis and management of ocular graft-versus-host disease
title_full Challenges and concepts in the diagnosis and management of ocular graft-versus-host disease
title_fullStr Challenges and concepts in the diagnosis and management of ocular graft-versus-host disease
title_full_unstemmed Challenges and concepts in the diagnosis and management of ocular graft-versus-host disease
title_short Challenges and concepts in the diagnosis and management of ocular graft-versus-host disease
title_sort challenges and concepts in the diagnosis and management of ocular graft-versus-host disease
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9987249/
https://www.ncbi.nlm.nih.gov/pubmed/36891189
http://dx.doi.org/10.3389/fmed.2023.1133381
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