PMID- 18093259
OWN - NLM
STAT- MEDLINE
DCOM- 20080708
LR  - 20220321
IS  - 1755-3768 (Electronic)
IS  - 1755-375X (Linking)
VI  - 86
IP  - 3
DP  - 2008 May
TI  - Dry-eye syndrome after allogeneic stem-cell transplantation in children.
PG  - 253-8
AB  - PURPOSE: To report the prevalence of dry-eye syndrome (DES) in children and young 
      adults treated with allogeneic stem-cell transplantation (SCT) during childhood; 
      to relate DES to conditioning regimes, including total body irradiation (TBI) and 
      chemotherapy, and to immunosuppressive drugs and graft-versus-host disease 
      (GVHD). METHODS: This cross-sectional study included 60 children/young adults 
      transplanted because of leukaemia, various haematological disorders and inborn 
      errors of metabolism between 1986 and 2004, with a follow-up time of 7.0 years 
      (median, range 2-18). Clinical assessments, performed at a median age of 15.6 
      years (range 5.5-23.5), included an inquiry form on dry-eye symptoms, corneal 
      status including fluorescein staining, 'break-up time' (BUT) and Schirmer test. 
      RESULTS: A total of 37 of 60 patients had DES defined as presence of corneal 
      epithelial lesions with a pathological BUT and/or Schirmer test. Twenty-nine had 
      had staining <1-10% of the corneal surface while eight patients had staining > or 
      =10-25% of the corneal surface. All 37 patients with objective signs of DES, 
      graded and not graded, had significant associations to subjective symptoms of dry 
      eyes including dry eyes, red eyes, ocular irritation, secretion and sensitivity 
      to light. Frequent occasions (above median; n = 7) of high cyclosporine A trough 
      levels above 250 ng/ml were associated significantly with DES (P = 0.002). 
      However, there was no association between DES and conditioning with single-dose 
      (s-TBI) or fractionated TBI (f-TBI), busulfan or other chemotherapy. There were 
      no associations between prolonged corticosteroid treatment or chronic GVHD and 
      DES in the present study. DES was more common in patients with malignant diseases 
      (P = 0.02). Malignant disease increased the risk of DES in girls but not in boys. 
      Increased age at SCT increased the risk for DES in boys but not in girls (P = 
      0.02). Although severe keratitis occurred in three patients, nobody suffered 
      corneal perforation. CONCLUSION: DES with epithelial punctata keratopathy was 
      common in children/young adults treated with SCT and more common if the patients 
      were exposed to repeated high trough levels of cyclosporine A; however, DES was 
      not associated with irradiation, corticosteroids or GVHD in the present study. 
      Patients with objective DES also had subjective symptoms of dry eyes, which 
      facilitate diagnosis. Girls with malignant diseases and boys who underwent SCT at 
      later ages seem to demand higher attention and more frequent check-ups regarding 
      DES. Patients with diagnosed severe DES needed frequent and continuous 
      ophthalmological care to maintain treatment motivation.
FAU - Fahnehjelm, Kristina Tear
AU  - Fahnehjelm KT
AD  - Department of Clinical Neuroscience, Karolinska Institut, Stockholm, Sweden. 
      kristina.fahnehjelm@ki.se
FAU - Tornquist, Alba-Lucia
AU  - Tornquist AL
FAU - Winiarski, Jacek
AU  - Winiarski J
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20071218
PL  - England
TA  - Acta Ophthalmol
JT  - Acta ophthalmologica
JID - 101468102
RN  - 0 (Adrenal Cortex Hormones)
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - Adolescent
MH  - Adrenal Cortex Hormones/adverse effects/therapeutic use
MH  - Age Factors
MH  - Child
MH  - Child, Preschool
MH  - Corneal Diseases/diagnosis/etiology
MH  - Cross-Sectional Studies
MH  - Dry Eye Syndromes/chemically induced/*etiology/physiopathology/therapy
MH  - Female
MH  - Follow-Up Studies
MH  - Graft vs Host Disease/complications
MH  - Humans
MH  - Immunosuppressive Agents/adverse effects
MH  - Infant
MH  - Male
MH  - Neoplasms/complications
MH  - Sex Factors
MH  - Staining and Labeling
MH  - Stem Cell Transplantation/*adverse effects
MH  - Tears/metabolism
MH  - Transplantation Conditioning/adverse effects
MH  - Transplantation, Homologous
MH  - Visual Acuity
EDAT- 2007/12/21 09:00
MHDA- 2008/07/09 09:00
CRDT- 2007/12/21 09:00
PHST- 2007/12/21 09:00 [pubmed]
PHST- 2008/07/09 09:00 [medline]
PHST- 2007/12/21 09:00 [entrez]
AID - AOS1120 [pii]
AID - 10.1111/j.1600-0420.2007.01120.x [doi]
PST - ppublish
SO  - Acta Ophthalmol. 2008 May;86(3):253-8. doi: 10.1111/j.1600-0420.2007.01120.x. 
      Epub 2007 Dec 18.