Infectious and Noninfectious Corneal Ulcers in Ocular Graft-Versus-Host Disease: Epidemiology, Clinical Characteristics, and Outcomes.
Infectious and Noninfectious Corneal Ulcers in Ocular Graft-Versus-Host Disease: Epidemiology, Clinical Characteristics, and Outcomes.
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眼移植物抗宿主病中的感染性和非感染性角膜溃疡：流行病学、临床特征和结果。
DOI：
10.1016/j.ajo.2023.09.018
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发表时间：
2024
影响因子：
4.2
通讯作者：
Tonk,Rahul
中科院分区：
文献类型：
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作者：
Sepulveda-Beltran,PaulaA;Carletti,Piero;Banda,Victor;Mulpuri,Lakshman;Levine,Harry;Amescua,Guillermo;Wang,TrentP;Galor,Anat;Tonk,Rahul
评估慢性眼移植物抗宿主病（coGVHD）患者角膜溃疡的发病率、临床特征、微生物学特征和治疗结果。回顾性临床队列研究。方法回顾2010年5月至2021年11月期间在巴斯科姆帕尔默眼科研究所接受造血干细胞移植（HSCT）后诊断为coGVHD的患者。收集基线人口统计学资料、临床特征、微生物学特征、角膜溃疡的风险因素和治疗结果。在培养阳性或适当临床情况（存在基质浸润或前房积脓）的个体中，病原学被认为是感染性的;否则，溃疡被认为是非感染性的。治疗成功定义为上皮再生伴浸润消退，治疗失败定义为进展为角膜穿孔或角膜移植术。Kaplan-Meier生存分析估计溃疡的发生率。考克斯回归分析研究人口统计学和风险因素。感染性和非感染性溃疡组采用双向独立检验、单因素方差分析和χ 2检验进行比较，共纳入173例患者（53.7±14.4岁，59.0%为男性）。33名患者在HSCT后74.5±54.3个月发生溃疡，估计5年和10年发生率分别为14%和30%。22例（66.6%）溃疡被认为是感染性的（15例微生物学证实，7例临床证实），11例（33.3%）被认为是非感染性的。角膜溃疡的危险因素包括黑人（风险比[HR] 2.89，95%CI 1.30- 6.42，P <0.01），既往眼部手术（HR 9.16，95%CI 3.86- 21.72，P < .01），睑缘异常（HR 3.44，95%CI 1.69- 6.99，P <0.01）和局部类固醇使用（HR 2.74，95%CI 1.33- 5.62，P <0.01）。相反，接触透镜的使用降低了角膜溃疡的风险（HR 0.29，95%CI 0.13- 0.66，P <0.01）。感染性溃疡的治疗失败率明显高于非感染性溃疡（57.1%vs20.0%，P = 0.04）。结论角膜溃疡是coGVHD的潜在并发症，有几个临床特征被认为是危险因素。感染性溃疡的预后比非感染性溃疡差。
PURPOSETo evaluate the incidence, clinical characteristics, microbiological profile, and therapeutic outcomes of corneal ulcers in individuals with chronic ocular graft-vs-host disease (coGVHD).DESIGNRetrospective clinical cohort study.METHODSReview of individuals diagnosed with coGVHD following hematopoietic stem cell transplantation (HSCT) who were seen at the Bascom Palmer Eye Institute between May 2010 and November 2021. Baseline demographics, clinical characteristics, microbiological profile, risk factors for corneal ulceration, and treatment outcomes were collected. Etiology was deemed infectious in individuals with a positive culture or appropriate clinical scenario (presence of stromal infiltrate or hypopyon); otherwise, ulcers were presumed to be noninfectious. Treatment success was defined as reepithelialization with infiltrate resolution, and treatment failure as progression to corneal perforation or keratoplasty. Kaplan-Meier survival analysis estimated the incidence of ulceration. Cox regression analyses examined demographic and risk factors. Infectious and noninfectious ulcer groups were compared using 2-way independentttests, 1-way analysis of variances, and χ2tests, as appropriate.RESULTS173 individuals were included (53.7±14.4 years old; 59.0% male). Thirty-three individuals developed an ulcer 74.5±54.3 months after HSCT, with estimated 5- and 10-year incidences of 14% and 30%, respectively. Twenty-two (66.6%) ulcers were deemed infectious (15 microbiologically confirmed, 7 clinically) and 11 (33.3%) were deemed noninfectious. Risk factors for corneal ulceration included Black race (hazards ratio [HR] 2.89, 95% CI 1.30-6.42,P< .01), previous ocular surgery (HR 9.16, 95% CI 3.86-21.72,P< .01), eyelid margin abnormalities (HR 3.44, 95% CI 1.69-6.99,P< .01), and topical steroid use (HR 2.74, 95% CI 1.33-5.62,P< .01). Conversely, contact lens use reduced the risk of corneal ulceration (HR 0.29, 95% CI 0.13-0.66,P< .01). Infectious ulcers had a significantly higher frequency of treatment failure than noninfectious ulcers (57.1% vs 20.0%,P= .04).CONCLUSIONCorneal ulceration is a potential complication of coGVHD, with several clinical features identified as risk factors. Infectious ulcers had worse outcomes than noninfectious ulcers.