Long-term clinical outcomes in chronic ocular graft-versus-host disease: a retrospective cohort study.

BACKGROUND

Chronic ocular graft-versus-host disease (oGVHD) is a debilitating complication of allogeneic hematopoietic stem cell transplantation (HSCT) that leads to persistent ocular surface damage, visual morbidity, and substantial treatment burden. Despite its prevalence, long-term outcome data remain limited.

METHODS

We conducted a retrospective cohort study of patients evaluated between 2012 and 2024 at a tertiary academic centre in Vancouver, Canada, with follow up of a year or more and recorded the outcomes of the first five years to characterise longitudinal ocular outcomes and therapeutic trajectories in patients with oGVHD.

RESULTS

A total of 189 patients met inclusion criteria. At baseline, meibomian gland dysfunction (81.5%) and superficial punctate keratitis (49.7%) were highly prevalent. Over five years, these manifestations remained persistent in over half of patients, while vision-threatening complications including filamentary keratitis (3.7%), corneal neovascularisation (2.6%), and limbal stem cell deficiency (4.8%) emerged. Therapeutic escalation was common, with 92.1% of patients requiring artificial tears, 47.1% serum tears, 28.0% punctal cautery, 19.0% scleral lenses, and 7.4% topical cyclosporine by year five. Baseline NIH Eye Scores correlated with later complications and treatment intensity, while NIH Lung and Mouth Scores were also predictive of ocular surface disease.

CONCLUSIONS

These findings underscore the progressive, treatment-resistant nature of oGVHD and highlight the value of early ophthalmic referral and multidisciplinary management to preserve vision and quality of life.