Abstract: High success rates for scleral lenses in graft-v-host-disease patients

These numbers are unsurprising to anyone who knows people with severe chronic GvHD (when they develop severe dry eye, among other things, following a bone marrow transplant for example), but nonetheless impressive:

• 97% of patients had improvement in quality of life
• 92% of patients continued to use sclerals (mean follow-up time was more than 1.5 years)
• Corneal damage, vision and quality of life were all assessed 2 months after starting and all improved

Bone Marrow Transplant. 2017 Jun;52(6):878-882. doi: 10.1038/bmt.2017.9. Epub 2017 Feb 20.

Scleral lenses for severe chronic GvHD-related keratoconjunctivitis sicca: a retrospective study by the SFGM-TC.

Magro L1,2, Gauthier J1,2, Richet M3, Robin M4, Nguyen S5, Suarez F6, Dalle JH7, Fagot T8, Huynh A9, Rubio MT10, Oumadely R11, Vigouroux S8, Milpied N8, Delcampe A12, Yakoub-Agha I1,2,13.

Author information

Abstract

Chronic GvHD-related keratoconjunctivitis sicca (cGvHD-related KCS) can significantly alter the quality of life of patients after allogeneic hematopoietic stem cell transplantation. The aim of this work was to assess the efficacy and tolerability of scleral lenses to treat severe cGvHD-related KCS. In this retrospective, multicenter study, we included 60 consecutive patients diagnosed with cGvHD-related KCS and fitted with scleral lenses. Patients were evaluated at baseline and at 2 months with the following tests: the Ocular Surface Disease Index (OSDI) to assess quality of life, the Oxford score to grade corneal damage and the logarithm of minimal angle of resolution (Log MAR) scale to determine visual acuity. We observed improvement in quality of life in 58 patients (97%). All parameters improved at 2 months. We observed significant differences at 2 months compared with baseline for the mean OSDI (86 versus 30, respectively, P<0 .001="" 0.10="" 0.33="" 1.3="" 2-125="" 20.5="" 5="" a="" acuity="" and="" as="" blockquote="" cgvhd-related="" discontinued="" efficient="" follow-up="" in="" kcs.="" lenses="" mar="" mean="" median="" months="" of="" og="" only="" oxford="" p="" patients="" range:="" respectively="" scleral="" score="" severe="" the="" tolerated="" treatment="" versus="" very="" visual="" was="" well="" were="" with="">

Abstract: Case reports of Cacicol use in Sjogrens patients with superficial ulcerative keratitis

Interesting case report on some folks with severe corneal disease. They clearly had to stay on it to get any kind of continued benefits, but those benefits sound pretty dramatic:

• decreased pain, burning, irritation and FBS
• improved vision
• healing of diffuse keratitis (after several months treatment)

Medicine (Baltimore). 2018 Mar;97(10):e9935.
Evaluation of a new matrix regenerating agent in patients with Sjögren syndrome and superficial ulcerative keratitis resistant to conventional therapy: A report of 3 cases.
Fajnkuchen F1,2, Barritault D3, Giocanti-Aurégan A1,4. 

Abstract
RATIONALE:
Sjögren syndrome (SS) is frequently associated with ulcerative keratitis, which is difficult to treat due to lacrimal tear deficiency and inflammation of the ocular surface. 

PATIENT CONCERNS:
We report the successful additive effect of a matrix regenerating agent (RGTA, Cacicol) in SS patients with severe superficial ulcerative keratitis resistant to conventional therapy. 

DIAGNOSES:
Retrospective, noncomparative case series of patients with primary or secondary SS associated with chronic diffuse keratitis. 

INTERVENTIONS:
All patients (3 women, aged 46, 59, and 84 years) had several years of dry-eye disease history and recurrent keratitis despite having used maximal dose topical therapies including artificial tear substitutes, topical vitamin A, and cyclosporine 0.05% emulsion. All patients suffered from dry, diffuse, and chronic superficial keratitis of at least 75% of the corneal surface, with no sign of corneal neovascularization or opacity. 

OUTCOMES:
RGTA treatment led to a rapid and marked decrease of ocular pain, burning, irritation, foreign body sensation, and improvement of visual acuity. Total diffuse keratitis healing occurred after several months of treatment. Discontinuation of RGTA administration led to the recurrence of severe keratitis; re-introduction of RGTA was successful. No local or systemic adverse effects related to treatment were reported. 

LESSONS:
RGTA treatment was effective and safe in this small series of 3 patients suffering from SS associated with recurrent or chronic superficial ulcerative keratitis resistant to conventional therapy.