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      Alterações oftalmológicas após transplante de medula óssea: análise de trinta e quatro pacientes com olho seco Translated title: Ophthalmologic changes after bone marrow transplantation: analyse of thirty-four patients with dry eye

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          Abstract

          RESUMO O transplante de medula óssea (TMO) tem sido o tratamento de escolha para várias doenças hematológicas severas. Uma das maiores complicações do transplante alogênico é a doença do enxerto-versus-hospedeiro (DECH), a qual ocorre em 50-70% dos casos. Aproximadamente 60% dos pacientes transplantados, que sofrem de DECH, apresentam comprometimento ocular, sendo a ceratoconjuntivite sicca a alteração mais comum. Neste estudo foram avaliados 34 pacientes pós-TMO com diagnóstico de ceratoconjuntivite sicca e destes, 27 pacientes apresentavam história de DECH. Após instituída a terapia convencional, 8 pacientes evoluíram para ceratite difusa persistente e 1 paciente evoluiu para úlcera periférica bilateral. Os resultados do presente estudo apontam para a necessidade de acompanhamento oftalmológico obrigatório para os pacientes submetidos ao transplante de medula óssea.

          Translated abstract

          SUMMARY Bone marrow transplantation (BMT) has been the treatment of choice for many severe hematologic diseases. The most important complication in the allogeneic transplantation is the graft-vs-host disease (GVHD), that occurs in 50-70% of the cases. Approximately 60% of the transplanted patients who developed GVHD, showed ocular damage, and keratoconjuntivitis sicca was the most common. In this study, thirty-four patients showed dry eye and from these, 27 (79,4%) patients developed GVHD, in agreement with the elevate correlation between dry eye and GVHD. After the iniciation of the conventional therapy, 04 patients developed persistent difuse keractitis and one, bilateral periferic ulcers. The results of this study, indicate the need of obligatory ophthalmologic accompaniment of the patients who underwent BMT.

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          Chronic graft-versus-host disease in 52 patients: adverse natural course and successful treatment with combination immunosuppression.

          Fifty-two of 175 (30%) survivors of allogeneic marrow transplantation developed chronic graft-versus-hose diseases (GVHD). Five with limited chronic GVHD had an indolent clinical course with involvement of only the skin and liver. Forty-seven with extensive chronic GVHD had an unfavorable multiorgan disorder that resembled several autoimmune diseases. Thirteen patients with extensive disease (group I) were not treated and only 2 survive with Karnofsky scores >- 70%. Mortality resulted from infections and morbidity from sica syndrome, pulmonary and hepatic insufficiency, scleroderma-like skin disease, and contractures. Another 13 (group II) received a median of 8 mo prednisone and/or a brief course of antithymocyte globulin, and 3 survive without disability. The other 21 (group III) were treated with a combination of prednisone (1.0 mg/kg/q.o.d.) and either cyclophosphamide, procarbazine, or azathioprine (all 1.5 mg/kg/day) for a median of 13 mo. Combination therapy was well tolerated with only modest myelotoxicity. Fifteen in group III had a good and 4 a fair response to treatment while 2 with no response died. Azathioprine and prednisone was the most effective regimen. All therapy has been discontinued in 12 group III patients: GVHD returned in 5 (including 2 who died in spite of retreatment) while 7 remain free of GVHD for a median of 11 (range 6-30) mo observation. Only I group III survivor is disabled and 16 of the original 21 are alive 2-4 yr after transplant with Karnofsky scores of 70%-100%. Thus, combination immmunosuppression appears to favorably affect and, in some cases, premanently arrest the adverse natural course of extensive chronic GVHD.
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            Ocular manifestations of graft-v-host disease.

            Graft-v-host disease is the major complication of bone marrow transplantation for the leukemias and aplastic anemia. In the clinical evaluation of eye problems of patients with acute graft-v-host disease, findings reveal a disease process of keratoconjunctivitis that appears to represent a specific pathologic eye syndrome in which the conjunctivae and occasionally the cornea represent an immunologic target of graft-v-host disease. Additional studies of eye problems of chronic graft-v-host disease reveal the persistent nature of keratitis sicca and the morbid sequelae of the immunoincompetent patient.
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              Dry eye syndrome in long-term follow-up of bone marrow transplanted patients.

              Out of 77 bone marrow transplanted patients surviving at least 1 year, 43% developed ocular manifestations of the sicca syndrome. This reaction was more frequent in patients with graft-versus-host disease (GVHD). Kerato-conjunctivitis sicca (KCS) developed in 28 patients (54%) who had survived acute GVHD but in only five cases (20%) of those without that complication. The incidence of dry eyes was 62% in the chronic GVHD group. All seven sicca cases in patients with aplastic anemia were seen in patients with chronic GVHD, while 10 out of 26 patients with hematological malignancies and without chronic GVHD had KCS. Two of these had not experienced any acute GVHD. Irradiation may contribute to the development of KCS, since all patients with hematological malignancies, in contrast to aplastic anemia patients, had undergone total body irradiation.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                abo
                Arquivos Brasileiros de Oftalmologia
                Arq. Bras. Oftalmol.
                Conselho Brasileiro de Oftalmologia (São Paulo, SP, Brazil )
                0004-2749
                1678-2925
                October 1997
                : 60
                : 5
                : 538-541
                Affiliations
                [3] orgnameServiço de Transplante de Medula Óssea Brazil
                [5] Paraná orgnameUniversidade Federal do Paraná orgdiv1curso de Medicina Brazil
                [1] Paraná orgnameUniversidade Federal do Paraná Brazil
                [4] Paraná orgnameUniversidade Federal do Paraná orgdiv1curso de Medicina Brazil
                [2] orgnameServiço de Transplante de Medula Óssea Brazil
                [6] Paraná orgnameUniversidade Federal do Paraná orgdiv1Hospital de Clínicas orgdiv2Departamento de Oftalmologia Brazil
                Article
                S0004-27491997000500538
                10.5935/0004-2749.19970037
                3ad6792b-7453-4788-9d25-86e3e487c6f9

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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                Transplante de medula óssea,Olho seco e doença do enxerto-versus-hospedeiro,Bone marrow transplantation,Dry eye and graft-versus-host disease

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