Purpose

To determine the prevalence, clinical characteristics, and risk factors associated with neurotrophic keratopathy (NK) in patients with chronic ocular graft-versus-host disease (oGVHD).

Design

Retrospective cohort study.

Methods

We performed a chart review of patients diagnosed with chronic oGVHD between January 2015 and December 2018 at a single academic institution and recorded demographic data, systemic and ocular comorbidities, history of hematologic malignancy, transplant characteristics, oGVHD severity scores, and adnexal and ocular examination findings. We determined the prevalence of NK and clinical characteristics associated with NK in these patients. A multivariate logistic regression analysis was performed to determine the risk factors associated with NK in these patients.

Main outcome measure

Prevalence of NK in chronic oGVHD.

Results

We identified 213 patients diagnosed with chronic oGVHD following hematopoietic stem cell or bone marrow transplantation from our electronic patient database, and the prevalence of NK was 14%. The mean age of oGVHD patients with NK was 62.6 ± 12.9 years; 48% were women, 19 had unilateral NK, and ten had bilateral NK. In the cohort, 56%, 20%, and 24% eyes of the patients had grades 1, 2, and 3 of NK, respectively. The mean time to diagnose NK after transplantation was 52.9 ± 45.4 months. oGVHD patients diagnosed with NK had a significantly higher NIH oGVHD severity score (p = 0.04) and a lower corneal sensation score (p = 0.0001) than those without NK. Our analyses showed a significantly higher CFS score (p = 0.01) and a trend toward lower Schirmer test scores (p = 0.16) and tear break-up times (p = 0.08) in oGVHD patients with NK. Additionally, we observed a significantly higher prevalence of persistent epithelial defect (p = 0.0001), corneal ulceration (p = 0.0001), and corneal perforation (p = 0.005) in oGVHD patients diagnosed with NK. A logistic regression analysis to determine factors associated with NK showed that a higher NIH oGVHD score (odds ratio [OR] = 2.03, p = 0.026) and history of cataract surgery (odds ratio [OR] = 5.03, p = 0.001) are significant risk factors for NK in oGVHD patients.

Conclusions

The prevalence of NK in chronic oGVHD patients was 14% during the study period. Our analysis shows that oGVHD patients with a higher NIH oGVHD severity score and previous history of cataract surgery are at a higher risk of developing NK and may develop severe sequelae such as persistent epithelial defect or corneal ulceration.

中文翻译：

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慢性眼移植物抗宿主病患者神经营养性角膜病变的患病率

目的

确定慢性眼移植物抗宿主病 (oGVHD) 患者中与神经营养性角膜病变 (NK) 相关的患病率、临床特征和危险因素。

设计

回顾性队列研究。

方法

我们对 2015 年 1 月至 2018 年 12 月期间在一家学术机构诊断为慢性 oGVHD 的患者进行了图表审查，并记录了人口统计数据、全身和眼部合并症、血液系统恶性肿瘤病史、移植特征、oGVHD 严重程度评分以及附件和眼部检查结果. 我们确定了这些患者中 NK 的患病率和与 NK 相关的临床特征。进行多变量逻辑回归分析以确定这些患者中与 NK 相关的危险因素。

主要成果指标

NK 在慢性 oGVHD 中的患病率。

结果

我们从我们的电子患者数据库中确定了 213 名在造血干细胞或骨髓移植后被诊断患有慢性 oGVHD的患者，NK 的患病率为 14%。患有 NK 的 oGVHD 患者的平均年龄为 62.6 ± 12.9 岁；48% 为女性，19 人患有单侧 NK，10 人患有双侧 NK。在队列中，分别有 56%、20% 和 24% 的患者眼睛有 1、2 和 3 级 NK。移植后诊断 NK 的平均时间为 52.9 ± 45.4 个月。被诊断患有 NK 的 oGVHD 患者的 NIH oGVHD 严重程度评分 (p = 0.04) 和角膜感觉评分 (p = 0.0001) 明显高于没有 NK 的患者。我们的分析显示 CFS 得分显着更高(p = 0.01) 并且Schirmer 测试有降低的趋势NK oGVHD 患者的评分（p = 0.16）和撕裂时间（p = 0.08）。此外，我们观察到在诊断为 NK 的 oGVHD 患者中，持续性上皮缺损(p = 0.0001)、角膜溃疡 (p = 0.0001) 和角膜穿孔 (p = 0.005) 的患病率显着升高。确定与 NK 相关因素的逻辑回归分析表明，较高的 NIH oGVHD 评分（比值比 [OR] = 2.03，p = 0.026）和白内障手术史（比值比 [OR] = 5.03，p = 0.001）是显着的oGVHD 患者 NK 的危险因素。

结论

在研究期间，慢性 oGVHD 患者的 NK 患病率为 14%。我们的分析表明，具有较高 NIH oGVHD 严重程度评分和既往白内障手术史的 oGVHD 患者发生 NK 的风险较高，并且可能会出现严重的后遗症，例如持续性上皮缺损或角膜溃疡。