Two case reports of continued progression of chronic ocular graft-versus-host disease without concurrent systemic comorbidities treated by amniotic membrane transplantation.
BACKGROUND
Chronic ocular graft-versus-host disease (oGVHD) is an ocular comorbidity of graft-versus-host disease (GVHD) that usually occurs concurrently with systemic manifestations. Failure to detect and treat oGVHD in its early stages may lead to progression of ocular signs and symptoms leading to oGVHD that is refractory to conventional treatment.


CASE PRESENTATION
We report the clinical course of a 19-year-old male and a 59-year-old female with severe and progressive chronic oGVHD without concurrent systemic signs of chronic graft-versus-host disease (cGVHD). Although their systemic conditions had been stable, both suffered from severe oGVHD and were referred to our clinic. Both cases exhibited marked improvement in conjunctival inflammation and fibrotic changes after amniotic membrane transplantation (AMT). Both cases underwent keratoplasty eventually to stabilize ocular surface conditions and to improve visual function.


CONCLUSIONS
We reported the clinical outcomes of 2 cases of chronic oGVHD without concurrent systemic comorbidities that were treated with AMT. The clinician should be aware that cGVHD may persist in target organs even in the absence of concurrent systemic comorbidities following seemingly successful systemic treatment. A multidisciplinary team approach is essential in the early detection and therapeutic intervention for chronic oGVHD.
['Ikarashi|Hideto|H|', 'Aketa|Naohiko|N|http://orcid.org/0000-0002-0188-1255', 'Shimizu|Eisuke|E|', 'Takano|Yoji|Y|', 'Kawakita|Tetsuya|T|', 'Uchino|Yuichi|Y|', 'Matsumoto|Yukihiro|Y|', 'Ogawa|Junko|J|', 'Tsubota|Kazuo|K|', 'Ogawa|Yoko|Y|']
D000328:Adult D000650:Amnion D002908:Chronic Disease D015897:Comorbidity D015352:Dry Eye Syndromes D005260:Female D006086:Graft vs Host Disease D018380:Hematopoietic Stem Cell Transplantation D006801:Humans D008297:Male D008875:Middle Aged D055815:Young Adult
Amniotic membrane transplantation Inflammation Dry eye disease Fibrosis Severe ocular GVHD