Wydanie 1/2006

Zaburzenia jakościowe i ilościowe filmu łzowego u pacjentów po przeszczepie szpiku

Qualitative and Quantitative Tear Film Disorders in Patients after Bone Marrow Transplantation

Magdalena Korwin-Rujna, Anna M. Ambroziak, Ewa Langwińska-Wośko, Sebastian Gajda

Katedra i Klinika Okulistyki II Wydziału Lekarskiego Akademii Medycznej w Warszawie
Kierownik: prof. dr hab. n. med. Jerzy Szaflik

Summary: Various complications occur including ocular ones occur in patients after bone marrow transplantation – BMT, similarly as in all patients after solid organs transplantation procedures (kidneys, liver, heart, lung, pancreatic islets), who are submitted to chronic immunosuppressive therapy, due to the GVHD (graft-versus-host-disease).
Purpose of the study: The purpose of the presented study was determination of qualitative and quantitative tear film disorders and dry eye syndrome symptoms intensification in patients after BMT.
Material and methods: 18 patients (36 eyes), 6 women and 12 men in the age range from 16 to 50 years were enrolled in the study. Follow-up took place from September the 1st, 2005 to May the 31st, 2006. Patients were followed-up in the 3 months interval. Patients were divided in 3 groups according to the ocular condition. During each visit we carried out basic ophthalmologic examination, digital photo of the anterior segment in the IMAGENET system and we have determined our own “sicca score” according to the following tests: Schirmer’s test, NBUT, tear film evaluation using Tearscope Plus by Keller and fluorescein and lisamine green staining along with impression cytology.
Results and conclusions: In patients from group II during follow-up period we have observed subjective and objective improvement in dry eye symptoms intensity. Only in patients from group III with advanced and severe dry eye problems we haven’t achieved satisfactory improvement in clinical condition, although they periodically observed decrease in dryness symptoms. In all studied individuals we observed significant tear film disturbances.
Patients on immunosuppressive therapy present many corneal complications, which should have considerable impact upon interdisciplinary cooperation between ophthalmologists and doctors treating patients after solid organs transplantations.

Keywords: GVHD, dry eye syndrome, tear film disorders, immunosuppressive therapy, BMT.