J Korean Ophthalmol Soc.  2022 Jul;63(7):592-601. 10.3341/jkos.2022.63.7.592.

Clinical Manifestation of Infectious Keratitis in Ocular Graft Versus Host Disease

• Jin HN
• Kim J
• Yoon HJ
• Yoon KC

• KMID: 2531822
• DOI: http://doi.org/10.3341/jkos.2022.63.7.592

Abstract

Purpose
We evaluated the clinical manifestations of, and risk factors for, infectious keratitis in patients with ocular graft-versus-host disease (GVHD).
Methods
A total of 11 patients who developed infectious keratitis after a diagnosis of ocular GVHD between January 2015 and December 2020, and 36 who did not (the control group), were included in this retrospective study. We recorded sex, age, any underlying disease, any other organ affected by systemic GVHD, systemic immunosuppressant use, follow-up duration, clinical manifestations, the severity of ocular GVHD prior to infection, the size of the epithelial defect, the depth of infiltration, hypopyon status, and the results of microbiological tests. Systemic and ocular indices (including systemic GVHD status) were compared using the chi-squared test. Risk factors for infection were identified.
Results
Of the corneal indices, the presence of corneal filaments, the extent of corneal neovascularization, and the number of corneal epithelial defects were significantly higher in the infected group (p = 0.023, p = 0.004, and p = 0.001, respectively). GVHD severity was also significantly higher in that group (p < 0.001). The presence of corneal filaments, corneal neovascularization, and corneal epithelial defects prior to infection correlated significantly with the risk of infection (p = 0.046, p = 0.010, and p = 0.003, respectively). Multivariate analysis identified corneal epithelial defects as a significant risk factor for infection (p = 0.029).
Conclusions
In patients with ocular GVHD, corneal epithelial defects, corneal neovascularization, and corneal filaments prior to infection were associated with the development of infection. In particular, corneal epithelial defects before infection was a significant risk factor for infection.

Keyword

Corneal epithelial defects; Corneal neovascularization; Infectious keratitis; Ocular graft-versus-host disease