Gas-permeable scleral lens for management of severe keratoconjunctivitis sicca secondary to chronic graft-versus-host disease

Introduction. - Graft-versus-host disease is a major complication of allogeneic hematopoietic stem cell transplantation. Severe keratoconjunctivitis sicca is common in patients with chronic GVH disease. The goal of this study was to evaluate the safety and efficacy of a gas-permeable scleral lens in the management of severe dry eye disease associated with chronic GVH. Patients and methods. - This is a retrospective study from June 2009 to November 2013. Patients fitted with scleral lenses for severe keratoconjunctivitis sicca associated with chronic GVH were included. The main outcomes measured were best-corrected visual acuity and quality of life (OSDI and NEI-VFQ25) composite scores before and six months after scleral lens fitting. Results. - Sixteen patients were included. The mean age was 52 years (19-69 years). Mean follow-up was 20 months (3-48 months). All patients reported improvement of their ocular symptoms. Best corrected visual acuity improved from 0.21 +/- 0.26 to 0.1 +/- 0.14 logMAR (P=0.002), OSDI score improved from 92.1 +/- 11.3 to 23.5 +/- 11.2 (P=0.002) and NEI-VFQ25 improved from 41.3 +/- 7 to 83.1 +/- 15.9 (P=0.003), 6 months after scleral lens fitting. No serious adverse events, infectious, hypoxemic or allergic complications attributable to the scleral lens occurred. Conclusion. - Gas-permeable scleral lens use appears to be safe and effective in patients with severe dry eye related to chronic GVH. (C) 2015 Elsevier Masson SAS. All rights reserved.