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Tseng AM, Heur M, Chiu GB. Sustained descemetocele management with Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) treatment. Am J Ophthalmol Case Rep 2024; 36:102092. [PMID: 39036656 PMCID: PMC11260373 DOI: 10.1016/j.ajoc.2024.102092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 04/16/2024] [Accepted: 06/07/2024] [Indexed: 07/23/2024] Open
Abstract
Purpose To report a case of a 67-year-old male who was successfully managed over a 7-year period for descemetocele secondary to ocular graft versus host disease (oGVHD) using Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) treatment. Observations We previously reported on a patient managed with a PROSE device for severe dry eyes secondary to oGVHD, who subsequently developed a central corneal descemetocele. The patient was deemed a poor surgical candidate due to limbal stem cell deficiency secondary to oGVHD. Therefore, we elected to closely monitor the descemetocele as the patient continued PROSE therapy. The patient's descemetocele has been managed successfully without perforation throughout a 7-year follow-up period with corrected distance visual acuity remaining stable at 20/50 in the affected eye. Conclusions and importance Descemetoceles are an uncommon complication of ocular graft versus host disease. This is the longest published report of a corneal descemetocele managed with PROSE. Our report suggests that in appropriate patients who are at high-risk for post-surgical complications, PROSE in conjunction with other medical management should be considered as an alternative to corneal transplantation.
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Affiliation(s)
- Alexander M. Tseng
- Department of Ophthalmology, USC Roski Eye Institute, University of Southern California Keck School of Medicine, 1450 San Pablo Street, 4th Floor, Los Angeles, CA, 90033, USA
| | - Martin Heur
- Department of Ophthalmology, USC Roski Eye Institute, University of Southern California Keck School of Medicine, 1450 San Pablo Street, 4th Floor, Los Angeles, CA, 90033, USA
| | - Gloria B. Chiu
- Department of Ophthalmology, USC Roski Eye Institute, University of Southern California Keck School of Medicine, 1450 San Pablo Street, 4th Floor, Los Angeles, CA, 90033, USA
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Lv X, Li H, Su S, Fan S. Advances in the ocular complications after hematopoietic stem cell transplantation. Ann Hematol 2024; 103:3867-3880. [PMID: 38403713 DOI: 10.1007/s00277-024-05678-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/18/2024] [Indexed: 02/27/2024]
Abstract
Hematopoietic stem cell transplantation (HSCT) has benefited an increasing number of patients with hematological disease in the clinic. It is a curative therapy for malignant and nonmalignant hematological diseases. With the advancement and further clinical application of HSCT in recent years, the life expectancy of patients has increased, but complications have become more common. The occurrence of ocular complications is receiving increasing attention because they can seriously affect the quality of life of patients. Ocular complications require increased attention from clinicians because of their negative impact on patients and increasing incidence. Most of recent reports on posttransplant ocular complications involve ocular manifestations of graft-versus-host disease (GVHD), and a few ocular complications that do not originate from GVHD have also been reported. This review summarizes the diagnosis, scoring criteria, pathophysiology, and clinical manifestations of and common therapies for ocular graft-versus-host disease(oGVHD) after HSCT, and includes a description of some rare cases and novel therapies.
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Affiliation(s)
- Xiaoli Lv
- Department of Hematology, First Affiliated Hospital, Harbin Medical University, Harbin, 150001, China
| | - Huibo Li
- Department of Hematology, First Affiliated Hospital, Harbin Medical University, Harbin, 150001, China
| | - Sheng Su
- Eye Hospital, First Affiliated Hospital, Harbin Medical University, Harbin, 150001, China.
| | - Shengjin Fan
- Department of Hematology, First Affiliated Hospital, Harbin Medical University, Harbin, 150001, China.
- NHC Key Laboratory of Cell Transplantation, First Affiliated Hospital, Harbin Medical University, Harbin, 150001, China.
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Koca DS, Dietrich-Ntoukas T. Frequency of Topical Immunomodulatory and Immunosuppressive Therapies for Ocular Chronic Graft-versus-Host Disease. J Clin Med 2024; 13:4728. [PMID: 39200870 PMCID: PMC11355837 DOI: 10.3390/jcm13164728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 08/04/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Introduction: The purpose of the study was to evaluate the frequency of topical immunomodulatory and immunosuppressive therapies in patients with ocular chronic graft-versus-host disease (cGVHD) in consideration of inflammatory activity and systemic immunosuppressive therapies in a tertiary care university hospital setting. Methods: We included 95 adult patients (48 male, 47 female) with ocular chronic graft-versus-host disease (cGVHD) after alloHSCT (median age 49.5 years). Clinical ophthalmological findings and the grade of ocular cGVHD according to the NIH eye score and the German-Austrian-Swiss Consensus (GAS) Grading were analyzed. Systemic GVHD manifestations as well as the prevalence of topical and systemic (immunomodulatory) therapies were assessed. Results: A total of 74 of 95 patients (77.8%) had manifestations of systemic chronic graft-versus-host disease other than ocular GVHD. 68.42% (65/95) of patients were under systemic immunosuppressive therapy with at least one immunosuppressive medication. All patients (95/95) received lid-margin hygiene and phosphate- and preservative-free lubricating eye drops. Twenty-five percent of the cohort (24/95) were treated with autologous serum eye drops (ASEDs). In total, 80% (76/95) of patients required topical steroid therapy to treat acute exacerbation of inflammation at least once; continuous topical steroid therapy was only necessary for a minor part (12%) with refractory chronic inflammation. A total of 92.63% (88/95) were primarily treated with ciclosporin A 0.1% as Ikervis®, of whom at least one third did not continue the therapy because of intolerable side effects during follow-up and received alternative topical formulations. Conclusions: Our data show that patients with ocular cGVHD mostly need topical therapy including anti-inflammatory agents despite systemic immunosuppressive therapy. In our cohort, 80% of patients received topical steroids, and more than 90% received topical ciclosporin A eye drops, which were tolerated by only two thirds of patients due to side effects.
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Affiliation(s)
| | - Tina Dietrich-Ntoukas
- Department of Ophthalmology, Charité—University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany;
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Singh RB, Cho W, Liu C, Naderi A, Surico PL, Kahale F, Dohlman TH, Chauhan SK, Dana R. Immunopathological mechanisms and clinical manifestations of ocular graft-versus-host disease following hematopoietic stem cell transplantation. Bone Marrow Transplant 2024; 59:1049-1056. [PMID: 38822141 DOI: 10.1038/s41409-024-02321-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 06/02/2024]
Abstract
Graft-versus-host disease is among the most common clinical complications following allogeneic hematopoietic stem cell transplantation. It causes inflammation-mediated destruction and dysfunction of various organ systems including ocular tissues in 60-90% of the patients and is termed ocular GVHD (oGVHD). In oGVHD, donor-derived T-cells recognize host antigens as foreign, resulting in immune dysregulation, inflammation and fibrosis of lacrimal glands, meibomian glands, cornea, and conjunctiva. The clinical presentation in oGVHD patients range from mild dry eye symptoms to catastrophic inflammation mediated pathological changes which can cause corneal perforation and blindness. In this review article, we provide detailed insights into the impact of mucosal barrier disruption, the afferent and efferent phases of immunological response involving activation of antigen presenting cells and T cells, respectively. We evaluate the evidence outlining the effector phase of the disease leading to cellular destruction and eventually fibrosis in patients with oGVHD. Finally, we discuss the well-established criteria for the diagnosis of oGVHD.
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Affiliation(s)
- Rohan Bir Singh
- Laboratory of Ocular Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Wonkyung Cho
- Laboratory of Ocular Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Catherine Liu
- Laboratory of Ocular Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Amirreza Naderi
- Laboratory of Ocular Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Pier Luigi Surico
- Laboratory of Ocular Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Francesca Kahale
- Laboratory of Ocular Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Thomas H Dohlman
- Laboratory of Ocular Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Sunil K Chauhan
- Laboratory of Ocular Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Reza Dana
- Laboratory of Ocular Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
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Pearson BG, Cortez RS, Khimani KS, Gupta PK. Ocular screening for chronic graft-versus-host disease in patients with allogeneic hematopoietic stem cell transplant. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00129-7. [PMID: 38796172 DOI: 10.1016/j.jcjo.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/26/2024] [Accepted: 04/14/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE This study investigates ocular manifestations of graft-versus-host disease in patients following allogeneic hematopoietic stem cell transplantation (HSCT) at the University of Texas Medical Branch (UTMB). Preferred practice pattern guidelines are proposed for ocular graft-versus-host disease (oGHVD) detection. METHODS The Epic electronic medical record database at UTMB was screened using International Classification of Diseases, Tenth Revision (ICD-10), codes for bone marrow transplants, stem cell transplants, and complications of bone marrow transplants and stem cell transplants. We identified 50 patients with the ICD-10 codes that were seen at UTMB between 2000 and 2021. Patients who received an HSCT and follow-up care with UTMB were included in this study. Thirty-eight patients met the inclusion criteria, whereas 12 patients were excluded because they had no diagnosis of HSCT or did not follow-up with UTMB. RESULTS Of the 38 patients in our cohort, 23.7% (n = 9) were noted to have oGVHD. As many as 89% of the patients with oGVHD presented with an ocular surface disease including keratoconjunctivitis sicca, meibomian gland dysfunction, and dry eye syndrome. Systemic GVHD also was found in 44% of the patients with oGVHD. Only 29% (n = 11) of the study population had referrals to ophthalmology. Most referrals (55%) were made within 1 year of getting the HSCT. None of the patients in our cohort received an ocular screening before HSCT. CONCLUSIONS Many post-HSCT patients lack routine ophthalmic care. Regularly assessing post-HSCT patients for early signs and symptoms of oGVHD may limit adverse outcomes. Management of oGVHD should involve a multidisciplinary team approach.
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Affiliation(s)
- Bryan G Pearson
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX
| | - Ray S Cortez
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX
| | - Karima S Khimani
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX; Ophthalmology Associates of San Antonio, San Antonio, TX
| | - Praveena K Gupta
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX.
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Mun CS, Surenkhuu B, Chen YF, Atassi N, Mun J, Kim C, Sheth T, Sarwar MA, Pradeep A, Jain S. Recombinant Deoxyribonuclease I Eye Drops for Ocular Graft Versus Host Disease: Results of a Randomized Clinical Trial. Eye Contact Lens 2024; 50:233-240. [PMID: 38407974 DOI: 10.1097/icl.0000000000001078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 02/28/2024]
Abstract
OBJECTIVE We have previously shown that neutrophil extracellular traps (NETs) are present on the ocular surface of patients with ocular graft versus host disease (oGVHD), contributing to inflammation and surface disease. Therefore, we performed a clinical trial using deoxyribonuclease I (DNAase) eye drops to test the hypothesis that reducing the abundance of NETs from the ocular surface will reduce signs and symptoms of oGVHD. METHODS A prospective, phase I or II, randomized, placebo-controlled, double-masked clinical trial was performed to determine the safety and preliminary efficacy of DNAase (0.1%) eye drops four times daily for 8 weeks in patients with oGVHD (n=58). Intent-to-treat analysis was performed to determine the change in safety outcome measures (drug tolerability and proportion of adverse events) and efficacy outcome measures (ocular surface disease index [OSDI] score and corneal staining) between baseline and week 8. RESULTS Tolerability and adverse events were similar in the vehicle and DNAase groups. Within the DNAase group (but not the vehicle group), corneal staining showed a statistically significant and clinically meaningful reduction at week 8 (3.50 [2.75; 5.00]) compared with baseline (5.00 [3.00; 7.00]). The OSDI score also showed a statistically significant clinically meaningful reduction of 18.4 (9.16; 33.1) ( P <0.001) at week 8 compared with baseline (45.5 [31.8; 50.0]) within the DNAase group. The proportion of eyes that had improvement in subjective global assessment (SGA) and mucous discharge was significantly greater in the DNAase group (55.6% and 57.7% at weeks 4 and 8, respectively; P <0.0001 at both time points) as compared with the vehicle group (35.7% and 34.0% at weeks 4 and 8, respectively). CONCLUSIONS Treatment of patients with oGVHD using DNAase eye drops is safe and demonstrates preliminary efficacy. Deoxyribonuclease I eye drops can potentially reduce the severity of signs and symptoms of ocular surface disease in patients with oGVHD.
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Affiliation(s)
- Christine S Mun
- Corneal Translational Biology Laboratory (C.S.M., B.S., N.A., J.M., C.K., T.S., A.P., S.J.), Department of Ophthalmology and Visual Sciences; Center for Clinical and Translational Science (Y.-F.C.); and Department of Pharmacy Practice (M.A.S.), University of Illinois at Chicago, Chicago, IL
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Liu S, Peng R, Ma J, Shen Z, Hu B, Zhao Y, Hong J. Assessment of Corneal Epithelial Changes and Related Factors in Ocular Chronic Graft-Versus-Host Disease (GVHD) by in Vivo Confocal Microscopy. Ocul Immunol Inflamm 2024; 32:454-462. [PMID: 36758227 DOI: 10.1080/09273948.2023.2173240] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 11/14/2022] [Accepted: 01/22/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE To evaluate corneal epithelial changes and related factors in chronic ocular graft-versus-host disease (oGVHD) patients. METHODS 21 patients (35 eyes) with chronic oGVHD and 8 patients (12 eyes) without oGVHD after bone marrow transplantation were recruited for assessment involving in vivo confocal microscopy (IVCM) analysis, ocular surface parameter determination and tear cytokine level analysis. The IVCM corneal epithelial scoring system was used to evaluate corneal epithelial changes. RESULTS There was a significant difference in the corneal epithelial score (p = .001) between the two groups. The corneal epithelial scores were significantly correlated with the corneal fluorescein staining scores (CFS, r = 0.463, p < .001), Schirmer's test (r = -0.389, p = .009) and tear cytokine levels of EGF (r = -0.491, p < .001) and APRIL (r = -0.318, p = .030). CONCLUSIONS The depth of corneal epithelial defects can be estimated by the CFS. Corneal epithelial changes of chronic oGVHD are considered to be associated with lacrimal deficiency and a lack of EGF.
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Affiliation(s)
- Shuwan Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Rongmei Peng
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Jiao Ma
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Zhan Shen
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Bohao Hu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Yinghan Zhao
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Jing Hong
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
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8
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Surenkhuu B, Mun CS, Kim C, Atassi NY, Mun J, Dhall N, Abdel-Hadi S, Sheth T, Dondeti P, Bernal A, Pradeep A, Rondelli D, Jain S. "Window of Opportunity" in Ocular Graft-Versus-Host Disease Treatment: Results of a Longitudinal Study and Case Reports. Eye Contact Lens 2024; 50:222-232. [PMID: 38477832 PMCID: PMC11037456 DOI: 10.1097/icl.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To perform a longitudinal study for determining the development of ocular graft-versus-host disease (oGVHD) after allogeneic hematopoietic stem cell transplant (HSCT) and report cases that illustrate the "window of opportunity" concept in oGVHD treatment. METHODS Patients (n=61) were examined at prescheduled clinic visits before HSCT and three-month intervals after HSCT for 2 years. The presence or absence of oGVHD was determined using the international chronic oGVHD consensus group diagnostic criteria. Ocular surface washings (OSW) were obtained at each visit and analyzed for cytokine levels. RESULTS In the longitudinal study, 26.2% (n=16; progressed group) developed either probable (11.5%, n=7) or definite oGVHD (14.8%, n=9). In the progressed group, clinically significant changes in signs (corneal staining and Schirmer I test) and symptoms at the post-HSCT visit as compared with the pre-HSCT visit occurred at 9 months. Significant differences in clinical signs and symptoms (whether average post-HSCT values or changes in values over pre-HSCT levels) between the progressed and nonprogressed groups occurred at a 9-month visit or later. In the progressed group, 55.6% of eyes that had negative matrix metalloproteinase 9 (MMP-9) test at pre-HSCT turned MMP-9 positive at 3 to 6 months post-HSCT. In the progressed group, interleukin 8 levels in OSW were significantly increased at 6 months post-HSCT. In the case reports, the "window of opportunity" was detected by MMP-9 turning positive, early corneal staining, interleukin 8 increase in OSW, and peripheral corneal epithelial thinning, which resolved with treatment initiation. CONCLUSIONS A "window of opportunity" exists before patients developing symptomatic tear-deficient dry eye after HSCT for initiating treatment that may preempt oGVHD development; however, larger-scale longitudinal studies are needed for definitive recommendations.
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Affiliation(s)
- Bayasgalan Surenkhuu
- Corneal Translational Biology Laboratory (B.S., C.S.M., C.K., N.Y.A., J.M., N.D., S.A.-H., T.S., P.D., A.B., A.P., S.J.), Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL; and Department of Medicine (D.R.), Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL
| | - Christine S. Mun
- Corneal Translational Biology Laboratory (B.S., C.S.M., C.K., N.Y.A., J.M., N.D., S.A.-H., T.S., P.D., A.B., A.P., S.J.), Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL; and Department of Medicine (D.R.), Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL
| | - Christian Kim
- Corneal Translational Biology Laboratory (B.S., C.S.M., C.K., N.Y.A., J.M., N.D., S.A.-H., T.S., P.D., A.B., A.P., S.J.), Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL; and Department of Medicine (D.R.), Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL
| | - Nour Yanna Atassi
- Corneal Translational Biology Laboratory (B.S., C.S.M., C.K., N.Y.A., J.M., N.D., S.A.-H., T.S., P.D., A.B., A.P., S.J.), Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL; and Department of Medicine (D.R.), Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL
| | - Jessica Mun
- Corneal Translational Biology Laboratory (B.S., C.S.M., C.K., N.Y.A., J.M., N.D., S.A.-H., T.S., P.D., A.B., A.P., S.J.), Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL; and Department of Medicine (D.R.), Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL
| | - Nikhil Dhall
- Corneal Translational Biology Laboratory (B.S., C.S.M., C.K., N.Y.A., J.M., N.D., S.A.-H., T.S., P.D., A.B., A.P., S.J.), Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL; and Department of Medicine (D.R.), Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL
| | - Sarah Abdel-Hadi
- Corneal Translational Biology Laboratory (B.S., C.S.M., C.K., N.Y.A., J.M., N.D., S.A.-H., T.S., P.D., A.B., A.P., S.J.), Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL; and Department of Medicine (D.R.), Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL
| | - Tanya Sheth
- Corneal Translational Biology Laboratory (B.S., C.S.M., C.K., N.Y.A., J.M., N.D., S.A.-H., T.S., P.D., A.B., A.P., S.J.), Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL; and Department of Medicine (D.R.), Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL
| | - Priyanka Dondeti
- Corneal Translational Biology Laboratory (B.S., C.S.M., C.K., N.Y.A., J.M., N.D., S.A.-H., T.S., P.D., A.B., A.P., S.J.), Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL; and Department of Medicine (D.R.), Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL
| | - Alexandria Bernal
- Corneal Translational Biology Laboratory (B.S., C.S.M., C.K., N.Y.A., J.M., N.D., S.A.-H., T.S., P.D., A.B., A.P., S.J.), Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL; and Department of Medicine (D.R.), Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL
| | - Anubhav Pradeep
- Corneal Translational Biology Laboratory (B.S., C.S.M., C.K., N.Y.A., J.M., N.D., S.A.-H., T.S., P.D., A.B., A.P., S.J.), Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL; and Department of Medicine (D.R.), Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL
| | - Damiano Rondelli
- Corneal Translational Biology Laboratory (B.S., C.S.M., C.K., N.Y.A., J.M., N.D., S.A.-H., T.S., P.D., A.B., A.P., S.J.), Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL; and Department of Medicine (D.R.), Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL
| | - Sandeep Jain
- Corneal Translational Biology Laboratory (B.S., C.S.M., C.K., N.Y.A., J.M., N.D., S.A.-H., T.S., P.D., A.B., A.P., S.J.), Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL; and Department of Medicine (D.R.), Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL
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Liu Y, Song S, Liu Y, Fu T, Guo Y, Liu R, Chen J, Lin Y, Cheng Y, Li Y, Guan T, Ling S, Zeng H. MSCohi-O lenses for long-term retention of mesenchymal stem cells on ocular surface as a therapeutic approach for chronic ocular graft-versus-host disease. Stem Cell Reports 2023; 18:2356-2369. [PMID: 37949071 PMCID: PMC10724054 DOI: 10.1016/j.stemcr.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 11/12/2023] Open
Abstract
Chronic ocular graft-versus-host disease (oGVHD) is a common complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) and can lead to vision loss if not diagnosed and treated promptly. Currently, no approved drugs exist for oGVHD treatment. However, umbilical cord-derived mesenchymal stem cells (UCMSCs) have known immunoregulatory properties and have been employed in clinical trials for immune-mediated diseases. To address oGVHD, the application of UCMSCs to the ocular surface is a logical approach. Intravenous administration of UCMSCs poses risks, necessitating topical and local delivery. Retaining UCMSCs on the ocular surface remains a challenge. To overcome this, we invented mesenchymal stem cell-coating high oxygen-permeable hydrogel lenses combining UCMSCs and machinery to enable the long-term retention of UCMSCs on the ocular surface. Animal model experiments demonstrated that these lenses effectively retained UCMSCs, providing therapeutic benefits by decreasing corneal inflammation and damage, and inhibiting immune rejection and response, all crucial aspects in oGVHD treatment.
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Affiliation(s)
- Yuanyue Liu
- Department of Stem Cell Research and Development, Guangdong Procapzoom Biosciences, Inc, Guangdong, China
| | - Siqi Song
- Department of Ophthalmology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Youyu Liu
- Department of Stem Cell Research and Development, Guangdong Procapzoom Biosciences, Inc, Guangdong, China
| | - Ting Fu
- Department of Stem Cell Research and Development, Guangdong Procapzoom Biosciences, Inc, Guangdong, China
| | - Yanzheng Guo
- Department of Stem Cell Research and Development, Guangdong Procapzoom Biosciences, Inc, Guangdong, China
| | - Ruoqing Liu
- Department of Stem Cell Research and Development, Guangdong Procapzoom Biosciences, Inc, Guangdong, China
| | - Jiexing Chen
- Department of Stem Cell Research and Development, Guangdong Procapzoom Biosciences, Inc, Guangdong, China
| | - Yanchun Lin
- Department of Stem Cell Research and Development, Guangdong Procapzoom Biosciences, Inc, Guangdong, China
| | - Yaqi Cheng
- Department of Ophthalmology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Yun Li
- Department of Stem Cell Research and Development, Guangdong Procapzoom Biosciences, Inc, Guangdong, China
| | - Tian Guan
- Department of Stem Cell Research and Development, Guangdong Procapzoom Biosciences, Inc, Guangdong, China
| | - Shiqi Ling
- Department of Ophthalmology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P.R. China.
| | - Haoyu Zeng
- Department of Stem Cell Research and Development, Guangdong Procapzoom Biosciences, Inc, Guangdong, China.
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Wang H, Yin X, Li Y, Zhang Z, Zhao K, Hu F, Liu Q, Lu Q, Wang Y, Zhang L, Jia H, Han J, Guo J, Li M. Safety and efficacy of intense pulsed light in the treatment of severe chronic ocular graft-versus-host disease. Ocul Surf 2023; 30:276-285. [PMID: 37813151 DOI: 10.1016/j.jtos.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/27/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE To investigate the safety and efficacy of intense pulsed light (IPL) in the treatment of severe chronic ocular graft-versus-host disease (coGVHD). METHODS A prospective cohort study. Seventeen patients with severe coGVHD were selected for inclusion in this study. All subjects were treated with IPL every fortnight together with conventional treatment, observation time points were pre-treatment (W0), 4 weeks post-treatment (W4), 8 weeks post-treatment (W8) and 12 weeks post-treatment (W12). Dry eye related examinations include Tear meniscus height (TMH), Non-invasive break-up time (NIBUT), Schirmer I test, Tear film lipid layer thickness (LLT), Ocular surface staining (OSS) and assessment of meibomian gland. Corneal epithelial cell morphology and inflammatory cell infiltration were analyzed by corneal confocal microscopy, while goblet cell density and squamous epithelial grade were assessed by conjunctival imprinted cytology. RESULTS Patients did not experience any adverse reactions during the follow-up period. All subjects showed significant improvement in clinical symptoms and most signs after IPL treatment. The corneal confocal microscopy showed that the number of dendritic cells infiltrates in the corneal stroma was significantly reduced after IPL treatment (p < 0.001). Conjunctival blot cytology suggested an increase in the number of conjunctival goblet cells from 5.12 ± 2.71 cells/mm2 before treatment to 22.00 ± 4.58 cells/mm2 after treatment, with a statistically significant difference (p < 0.001). An improvement in conjunctival epithelial cell morphology and a decrease in squamous epithelial grade was also observed. CONCLUSIONS IPL treatment can effectively increase tear film stability in patients with severe coGVHD without significant side effects.
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Affiliation(s)
- He Wang
- From the Department of Ophthalmology, The Affiliated Hospital of Xuzhou Medical University, Huai Hai West Street 99, Xuzhou, 221000, Jiangsu Province, China
| | - Xiaoyue Yin
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Yue Li
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Zhaowei Zhang
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Kai Zhao
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Fen Hu
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Qian Liu
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Qiuchen Lu
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Yining Wang
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Ling Zhang
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Hui Jia
- From the Institute of Environment and Ecology, Institute of Environmental Health and Ecological Security, School of the Environment and Safety Engineering, Jiangsu University, Zhenjiang, 212013, Jiangsu Province, China
| | - Jiaxin Han
- College of Optometry, Wenzhou Medical University, Wenzhou, 325027, Zhejiang Province, China
| | - Jianxin Guo
- From the Department of Ophthalmology, The Affiliated Hospital of Xuzhou Medical University, Huai Hai West Street 99, Xuzhou, 221000, Jiangsu Province, China
| | - Mingxin Li
- From the Department of Ophthalmology, The Affiliated Hospital of Xuzhou Medical University, Huai Hai West Street 99, Xuzhou, 221000, Jiangsu Province, China.
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11
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He Y, Wong H, Gu J, Lin L. Corneal Descemetocele Management with Multi-Layer Amniotic Membrane Transplantation in an Ocular Graft-versus-Host Disease Case. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1733. [PMID: 37893451 PMCID: PMC10607979 DOI: 10.3390/medicina59101733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/16/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023]
Abstract
Background: Chronic ocular graft-versus-host disease (oGVHD) is a common ocular complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT), characterized by progressive inflammation of the ocular surface and refractory dry eye. In severe cases, sterile corneal perforation can occur, which poses a significant challenge, due to the low survival rate of grafts after corneal transplantation. Case Presentation: A 47-year-old female presented to our hospital with persistent dryness, foreign body sensation, and blurred vision in her left eye. Diagnosis of graft-versus-host disease with corneal descemetocele in the left eye was made after detailed history review and thorough examination. Multi-layer amniotic membrane transplantation was performed in the affected eye, resulting in amelioration of the patient's symptoms. This amelioration of symptoms provided the patient with a level of comfort that permitted additional time while awaiting corneal transplantation. Conclusions: We report a successful case of multi-layer amniotic membrane transplantation for the management of corneal descemetocele following allo-HSCT.
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Affiliation(s)
- Yunjiao He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou 510060, China; (Y.H.); (H.W.); (J.G.)
- Department of Laboratory, Dehong People’s Hospital, Dehong 678400, China
| | - Hiufong Wong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou 510060, China; (Y.H.); (H.W.); (J.G.)
| | - Jianjun Gu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou 510060, China; (Y.H.); (H.W.); (J.G.)
| | - Lixia Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou 510060, China; (Y.H.); (H.W.); (J.G.)
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12
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Tian Y, Zhang T, Li J, Tao Y. Advances in development of exosomes for ophthalmic therapeutics. Adv Drug Deliv Rev 2023; 199:114899. [PMID: 37236425 DOI: 10.1016/j.addr.2023.114899] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/18/2023] [Accepted: 05/21/2023] [Indexed: 05/28/2023]
Abstract
Exosomes contain multiple bioactive molecules and maintain the connection between cells. Recent advances in exosome-based therapeutics have witnessed unprecedented opportunities in treating ophthalmic diseases, including traumatic diseases, autoimmune diseases, chorioretinal diseases and others. Utilization of exosomes as delivery vectors to encapsulate both drugs and therapeutic genes could yield higher efficacy and avoid the unnecessary immune responses. However, exosome-based therapies also come with some potential ocular risks. In this review, we first present a general introduction to exosomes. Then we provide an overview of available applications and discuss their potential risks. Moreover, we review recently reported exosomes as delivery vectors for ophthalmic diseases. Finally, we put forward future perspectives to grapple with its translation and underlying issues.
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Affiliation(s)
- Ying Tian
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Tao Zhang
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Jing Li
- Beijing Key Laboratory of DNA Damage Response, College of Life Sciences, Capital Normal University, Beijing 100048, PR China
| | - Yong Tao
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, PR China.
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13
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Roshandel D, Semnani F, Rayati Damavandi A, Masoudi A, Baradaran-Rafii A, Watson SL, Morgan WH, McLenachan S. Genetic predisposition to ocular surface disorders and opportunities for gene-based therapies. Ocul Surf 2023; 29:150-165. [PMID: 37192706 DOI: 10.1016/j.jtos.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/24/2023] [Accepted: 05/09/2023] [Indexed: 05/18/2023]
Abstract
The ocular surface, comprised of the corneal and conjunctival epithelium, innervation system, immune components, and tear-film apparatus, plays a key role in ocular integrity as well as comfort and vision. Gene defects may result in congenital ocular or systemic disorders with prominent ocular surface involvement. Examples include epithelial corneal dystrophies, aniridia, ectrodactyly-ectodermal dysplasia-clefting (EEC) syndrome, xeroderma pigmentosum (XP), and hereditary sensory and autonomic neuropathy. In addition, genetic factors may interact with environmental risk factors in the development of several multifactorial ocular surface disorders (OSDs) such as autoimmune disorders, allergies, neoplasms, and dry eye disease. Advanced gene-based technologies have already been introduced in disease modelling and proof-of-concept gene therapies for monogenic OSDs. For instance, patient-derived induced pluripotent stem cells have been used for modelling aniridia-associated keratopathy (AAK), XP, and EEC syndrome. Moreover, CRISPR/Cas9 genome editing has been used for disease modelling and/or gene therapy for AAK and Meesmann's epithelial corneal dystrophy. A better understanding of the role of genetic factors in OSDs may be helpful in designing personalized disease models and treatment approaches. Gene-based approaches in monogenic OSDs and genetic predisposition to multifactorial OSDs such as immune-mediated disorders and neoplasms with known or possible genetic risk factors has been seldom reviewed. In this narrative review, we discuss the role of genetic factors in monogenic and multifactorial OSDs and potential opportunities for gene therapy.
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Affiliation(s)
- Danial Roshandel
- Lions Eye Institute, Perth, WA, Australia; Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, WA, Australia
| | - Farbod Semnani
- School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran; School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Amirmasoud Rayati Damavandi
- School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran; School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ali Masoudi
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Alireza Baradaran-Rafii
- Department of Ophthalmology, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Stephanie L Watson
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
| | - William H Morgan
- Lions Eye Institute, Perth, WA, Australia; Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, WA, Australia
| | - Samuel McLenachan
- Lions Eye Institute, Perth, WA, Australia; Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, WA, Australia.
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14
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Abraham AR, Maghsoudlou P, Copland DA, Nicholson LB, Dick AD. CAR-Treg cell therapies and their future potential in treating ocular autoimmune conditions. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1184937. [PMID: 38983082 PMCID: PMC11182176 DOI: 10.3389/fopht.2023.1184937] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/03/2023] [Indexed: 07/11/2024]
Abstract
Ophthalmic autoimmune and autoinflammatory conditions cause significant visual morbidity and require complex medical treatment complicated by significant side effects and lack of specificity. Regulatory T cells (Tregs) have key roles in immune homeostasis and in the resolution of immune responses. Polyclonal Treg therapy has shown efficacy in treating autoimmune disease. Genetic engineering approaches to produce antigen-specific Treg therapy has the potential for enhanced treatment responses and fewer systemic side effects. Cell therapy using chimeric antigen receptor modified T cell (CAR-T) therapy, has had significant success in treating haematological malignancies. By modifying Tregs specifically, a CAR-Treg approach has been efficacious in preclinical models of autoimmune conditions leading to current phase 1-2 clinical trials. This review summarises CAR structure and design, Treg cellular biology, developments in CAR-Treg therapies, and discusses future strategies to apply CAR-Treg therapy in the treatment of ophthalmic conditions.
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Affiliation(s)
- Alan R. Abraham
- Ophthalmology Research Group, Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Panayiotis Maghsoudlou
- Ophthalmology Research Group, Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
- University of Bath, Bath, United Kingdom
| | - David A. Copland
- Ophthalmology Research Group, Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Lindsay B. Nicholson
- Ophthalmology Research Group, Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Andrew D. Dick
- Ophthalmology Research Group, Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
- UCL-Institute of Ophthalmology, University College London, London, United Kingdom
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15
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Yan F, Liu Y, Zhang T, Shen Y. Identifying TNF and IL6 as potential hub genes and targeted drugs associated with scleritis: A bio-informative report. Front Immunol 2023; 14:1098140. [PMID: 37063831 PMCID: PMC10102337 DOI: 10.3389/fimmu.2023.1098140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/22/2023] [Indexed: 04/03/2023] Open
Abstract
BackgroundScleritis is a serious inflammatory eye disease that can lead to blindness. The etiology and pathogenesis of scleritis remain unclear, and increasing evidence indicates that some specific genes and proteins are involved. This study aimed to identify pivotal genes and drug targets for scleritis, thus providing new directions for the treatment of this disease.MethodsWe screened candidate genes and proteins associated with scleritis by text-mining the PubMed database using Python, and assessed their functions by using the DAVID database. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were used to identify the functional enrichment of these genes and proteins. Then, the hub genes were identified with CytoHubba and assessed by protein-protein interaction (PPI) network analysis. And the serum from patients with active scleritis and healthy subjects were used for the validation of hub genes. Finally, the DGIdb database was used to predict targeted drugs for the hub genes for treating scleritis.ResultsA total of 56 genes and proteins were found to be linked to scleritis, and 65 significantly altered pathways were identified in the KEGG analysis (FDR < 0.05). Most of the top five pathways involved the categories “Rheumatoid arthritis,” “Inflammatory bowel disease”, “Type I diabetes mellitus,” and “Graft-versus-host disease”. TNF and IL6 were considered to be the top 2 hub genes through CytoHubba. Based on our serum samples, hub genes are expressed at high levels in active scleritis. Five scleritis-targeting drugs were found among 88 identified drugs.ConclusionsThis study provides key genes and drug targets related to scleritis through bioinformatics analysis. TNF and IL6 are considered key mediators and possible drug targets of scleritis. Five drug candidates may play an important role in the diagnosis and treatment of scleritis in the future, which is worthy of the further experimental and clinical study.
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Affiliation(s)
- Feiyue Yan
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
- Frontier Science Center of Immunology and Metabolism, Medical Research Institute, Wuhan University, Wuhan, China
| | - Yizong Liu
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tianlu Zhang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yin Shen
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
- Frontier Science Center of Immunology and Metabolism, Medical Research Institute, Wuhan University, Wuhan, China
- *Correspondence: Yin Shen,
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16
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Cheng X, Huang R, Fan W, Huang S, Zeng L, Wu T, Yuan R, Wang X, Zhang X. The tear cytokine panel is a useful biomarker for early diagnosis and severity-evaluating of ocular chronic graft-versus-host disease. Bone Marrow Transplant 2023:10.1038/s41409-023-01952-2. [PMID: 36977925 DOI: 10.1038/s41409-023-01952-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/28/2023] [Accepted: 03/08/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Xianjing Cheng
- School of Medicine, Chongqing University, Chongqing, 400030, China
- Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, 400037, China
| | - Ruihao Huang
- Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, 400037, China
| | - Wei Fan
- Department of Ophthalmology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Shiqin Huang
- Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, 400037, China
| | - Lingyu Zeng
- Department of Hematology, Blood Diseases Institute, Xuzhou Medical University, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, China
| | - Tao Wu
- Department of Hematology, Center of Hematologic Diseases of Chinese PLA, Lanzhou Military Command General Hospital, Lanzhou, 730050, Gansu, China
| | - Rongdi Yuan
- Department of Ophthalmology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China.
| | - Xiaoqi Wang
- Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, 400037, China.
| | - Xi Zhang
- School of Medicine, Chongqing University, Chongqing, 400030, China.
- Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, 400037, China.
- Jinfeng Laboratory, Chongqing, 400037, China.
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17
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Perez VL, Mousa HM, Soifer M, Beatty C, Sarantopoulos S, Saban DR, Levy RB. Meibomian Gland Dysfunction: A Route of Ocular Graft-Versus-Host Disease Progression That Drives a Vicious Cycle of Ocular Surface Inflammatory Damage. Am J Ophthalmol 2023; 247:42-60. [PMID: 36162534 PMCID: PMC10270654 DOI: 10.1016/j.ajo.2022.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To investigate the role of aggressive meibomian gland dysfunction (MGD) in the immune pathogenesis of ocular graft-vs-host disease (GVHD). METHODS In mice, an allogeneic GVHD model was established by transferring bone marrow (BM) and purified splenic T cells from C57BL/6J mice into irradiated C3-SW.H2b mice (BM+T). Control groups received BM only. Mice were scored clinically across the post-transplantation period. MGD severity was categorized using the degree of atrophy on harvested lids. Immune disease was analyzed using flow cytometry of tissues along with fluorescent tracking of BM cells onto the ocular surface. In humans, parameters from 57 patients with ocular GVHD presenting to the Duke Eye Center were retrospectively reviewed. MGD was categorized using the degree of atrophy on meibographs. Immune analysis was done using high-parameter flow cytometry on tear samples. RESULTS Compared with BM only, BM+T mice had higher systemic disease scores that correlated with tear fluid loss and eyelid edema. BM+T had higher immune cell infiltration in the ocular tissues and higher CD4+-cell cytokine expression in draining lymph nodes. BM+T mice with worse MGD scores had significantly worse corneal staining. In patients with ocular GVHD, 96% had other organs affected. Patients with ocular GVHD had abnormal parameters on dry eye testing, high matrix metalloproteinase-9 positivity (92%), and abundance of immune cells in tear samples. Ocular surface disease signs were worse in patients with higher MGD severity scores. CONCLUSIONS Ocular GVHD is driven by a systemic, T-cell-dependent process that causes meibomian gland damage and induces a robust form of ocular surface disease that correlates with MGD severity. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Victor L Perez
- Foster Center for Ocular Immunology, Department of Ophthalmology (V.L.P., H.M.M., M.S.); Duke Eye Center, Duke University School of Medicine; Department of Immunology, Duke University Medical Center (C.B., D.R.S.).
| | - Hazem M Mousa
- Foster Center for Ocular Immunology, Department of Ophthalmology (V.L.P., H.M.M., M.S.); Duke Eye Center, Duke University School of Medicine; Department of Immunology, Duke University Medical Center (C.B., D.R.S.)
| | - Matias Soifer
- Foster Center for Ocular Immunology, Department of Ophthalmology (V.L.P., H.M.M., M.S.); Duke Eye Center, Duke University School of Medicine; Department of Immunology, Duke University Medical Center (C.B., D.R.S.)
| | - Cole Beatty
- Duke Eye Center, Duke University School of Medicine; Department of Immunology, Duke University Medical Center (C.B., D.R.S.)
| | - Stefanie Sarantopoulos
- Division of Hematological Malignancies and Cellular Therapy, Duke University Department of Medicine, Duke Cancer Institute (S.S.) Durham, North Carolina
| | - Daniel R Saban
- Duke Eye Center, Duke University School of Medicine; Department of Immunology, Duke University Medical Center (C.B., D.R.S.)
| | - Robert B Levy
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, Florida (R.B.L.), USA
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18
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Tappeiner C, Heiligenhaus A, Halter JP, Miserocchi E, Bandello F, Goldblum D. Challenges and concepts in the diagnosis and management of ocular graft-versus-host disease. Front Med (Lausanne) 2023; 10:1133381. [PMID: 36891189 PMCID: PMC9987249 DOI: 10.3389/fmed.2023.1133381] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/18/2023] [Indexed: 02/19/2023] Open
Abstract
Graft-versus-host disease (GVHD) is characterized by tissue inflammation in the host following an allogeneic hematopoietic cell transplantation (HCT). The pathophysiology is complex and only incompletely understood yet. Donor lymphocyte interaction with the histocompatibility antigens of the host plays a crucial role in the pathogenesis of the disease. Inflammation may affect multiple organs and tissues, e.g., the gastrointestinal tract, liver, lung, fasciae, vaginal mucosa, and the eye. Subsequently, alloreactive donor-derived T and B lymphocytes may lead to severe inflammation of the ocular surface (i.e., cornea and conjunctiva) and the eyelids. Furthermore, fibrosis of the lacrimal gland may lead to severe dry eye. This review focuses on ocular GVHD (oGVHD) and provides an overview of current challenges and concepts in the diagnosis and management of oGVHD. Ophthalmic manifestations, diagnostic procedures, grading of severity and recommendations for ophthalmic examination intervals are provided. Management of ocular surface disease with lubricants, autologous serum eye drops, topical anti-inflammatory agents and systemic treatment options are described based on the current evidence. Ocular surface scarring and corneal perforation are severe complications of oGVHD. Therefore, ophthalmic screening and interdisciplinary treatment approaches are highly relevant to improve the quality of life of patients and to prevent potentially irreversible visual loss.
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Affiliation(s)
- Christoph Tappeiner
- Department of Ophthalmology, Pallas Klinik, Olten, Switzerland.,Department of Ophthalmology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy.,Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Arnd Heiligenhaus
- Department of Ophthalmology at St. Franziskus Hospital, Muenster, Germany
| | - Joerg P Halter
- Department of Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Elisabetta Miserocchi
- Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
| | - David Goldblum
- Department of Ophthalmology, Pallas Klinik, Olten, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
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19
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Cheng X, Huang R, Huang S, Fan W, Yuan R, Wang X, Zhang X. Recent advances in ocular graft-versus-host disease. Front Immunol 2023; 14:1092108. [PMID: 36761771 PMCID: PMC9905686 DOI: 10.3389/fimmu.2023.1092108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023] Open
Abstract
Ocular graft-versus-host-disease (GVHD) remains a significant clinical complication after allogeneic hematopoietic stem cell transplantation. Impaired visual function, pain, and other symptoms severely affect affected individuals' quality of life. However, the diagnosis of and therapy for ocular GVHD involve a multidisciplinary approach and remain challenging for both hematologists and ophthalmologists, as there are no unified international criteria. Through an exploration of the complex pathogenesis of ocular GVHD, this review comprehensively summarizes the pathogenic mechanism, related tear biomarkers, and clinical characteristics of this disease. Novel therapies based on the mechanisms are also discussed to provide insights into the ocular GVHD treatment.
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Affiliation(s)
- Xianjing Cheng
- Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, China.,School of Medicine, Chongqing University, Chongqing, China
| | - Ruihao Huang
- Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, China
| | - Shiqin Huang
- Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, China
| | - Wei Fan
- Department of Ophthalmology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Rongdi Yuan
- Department of Ophthalmology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xiaoqi Wang
- Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, China
| | - Xi Zhang
- Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, China.,School of Medicine, Chongqing University, Chongqing, China.,Jinfeng Laboratory, Chongqing, China
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20
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Zhuang XY, Sun ZT, Xu Y, Ren YR, Chen YJ, Chen F, Ma X, Tang XW, Zhang XF. Correlative factors of ocular surface lesions after allogeneic hematopoietic stem cell transplantation: A retrospective study. Front Oncol 2022; 12:1040679. [PMID: 36479063 PMCID: PMC9719980 DOI: 10.3389/fonc.2022.1040679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/07/2022] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND Ocular graft-versus-host disease (oGVHD) is one of the complications after allogeneic hematopoietic stem cell transplantation (HSCT), which impairs the quality of life and may indicate poor prognosis. In this retrospective study, the aim was to investigate the characteristics of ocular surface after HSCT, and analyze the risk factors related to the severity of ocular surface lesions. METHODS 248 post-HSCT patients were enrolled in this retrospective study. Subjects were divided into no lesion group, mild lesion group and severe lesion group, according to the severity of ocular surface lesions. The correlations between grades of ocular surface lesions and gender, age, primary disease, donor source, human leukocyte antigen (HLA) type, kinship, donor-recipient relationship, blood type, source of stem cell and systemic GVHD were analyzed. RESULTS The median scores of corneal epitheliopathy, lid margin lesions and meibomian gland loss were 3, 6 and 2 points, respectively. The grade of corneal epitheliopathy was related to donor source (P<0.001), kinship (P=0.033), HLA-matching (P<0.001), and systemic GVHD (P=0.007), especially oral GVHD (P<0.001) and liver GVHD (P=0.002). The grade of lid margin lesions was related to donor source (P=0.019), HLA-matching (P=0.006), and systemic GVHD (P=0.013), especially skin GVHD (P=0.019) and oral GVHD (P=0.019). The grade of meibomian gland loss was related to age (P=0.035) and gastrointestinal GVHD (P=0.007). The grade of corneal epitheliopathy after HSCT was related to the lid margin lesion score (P<0.001). CONCLUSIONS The occurrence and development of ocular GVHD are mostly accompanied by the history of systemic GVHD. While in few cases, ocular surface lesions related to GVHD can be observed prior to the rejection of other tissues and organs. Severe corneal epitheliopathy occurs in patients with severe lid margin lesions in ocular GVHD. The lesions of corneal epithelium and lid margin are milder in HLA partially matching transplantation.
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Affiliation(s)
- Xin-Yu Zhuang
- Department of Ophthalmology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zheng-Tai Sun
- Department of Ophthalmology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yue Xu
- Department of Ophthalmology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Ya-Ru Ren
- Department of Ophthalmology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ying-Jie Chen
- Department of Ophthalmology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Feng Chen
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Xiao Ma
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Xiao-Wen Tang
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Xiao-Feng Zhang
- Department of Ophthalmology, First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Ophthalmology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
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21
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Cheng XJ, Yuan RD, Zhang X. [Treatment of chronic ocular graft versus host disease]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:877-880. [PMID: 36709206 PMCID: PMC9669625 DOI: 10.3760/cma.j.issn.0253-2727.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Indexed: 01/25/2023]
Affiliation(s)
- X J Cheng
- Medical Center of Hematology, Xinqiao Hospital of Army Medical University, State Key Laboratory of Trauma, Burns and Combined Injury, PLA Blood Disease Center, Chongqing Key Discipline of Medicine, Chongqing 400037, China School of Medicine Chongqing University, Chongqing 400030, China
| | - R D Yuan
- Ophthalmology Department, Xinqiao Hospital of Army Medical University, Chongqing 400037, China
| | - X Zhang
- Medical Center of Hematology, Xinqiao Hospital of Army Medical University, State Key Laboratory of Trauma, Burns and Combined Injury, PLA Blood Disease Center, Chongqing Key Discipline of Medicine, Chongqing 400037, China School of Medicine Chongqing University, Chongqing 400030, China
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22
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Wang S, Singh RB, Yuksel E, Musayeva A, Sinha S, Taketani Y, Dohlman TH, Dana R. Ocular pain in ocular graft-versus-host disease patients with neurotrophic keratopathy. Ocul Surf 2022; 26:142-147. [PMID: 35948166 DOI: 10.1016/j.jtos.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/11/2022] [Accepted: 07/21/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE Neurotrophic keratopathy (NK) is a degenerative disorder of the cornea characterized by decreased sensory innervation, epitheliopathy, and impaired epithelial healing. In this study, we assessed ocular pain and quality-of-life-related parameters in ocular graft-versus-host disease (oGVHD) patients with and without NK. METHODS We included 213 oGVHD patients in this retrospective study, including 29 patients with NK assessed by the Cochet-Bonnet esthesiometer. We evaluated their records for ocular pain assessment survey (OPAS) scores and clinical parameters, including corneal sensation, corneal fluorescein staining (CFS) score, Schirmer's test, tear break-up time (TBUT), and ocular surface disease index (OSDI) score. RESULTS oGVHD patients with NK had lower corneal sensation (3.4 ± 1.4 vs. 5.9 ± 0.3; p < 0.0001), higher CFS scores (6.4 ± 4.2 vs. 4.7 ± 4.0; p = 0.01), and lower TBUT scores (1.2 ± 2.1 vs. 2.2 ± 3.1; p = 0.08) compared to oGVHD patients without NK and additionally had significantly higher ocular pain intensity scores (OPAS 24-h average eye pain intensity: 2.0 ± 2.8 vs. 1.1 ± 1.9; p = 0.03). Patients with NK more commonly reported burning (0.2 ± 0.3 vs. 0.3 ± 0.4; p = 0.021) and sensitivity to light (0.2 ± 0.3 vs. 0.3 ± 0.4; p = 0.049) as compared to patients without NK. CONCLUSION Clinical signs of ocular surface disease are worse in oGVHD patients with NK compared to oGVHD patients without NK. These patients additionally experience higher intensity ocular pain and lower quality-of-life-related parameters.
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23
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Doctor MB, Basu S. Lacrimal Gland Insufficiency in Aqueous Deficiency Dry Eye Disease: Recent Advances in Pathogenesis, Diagnosis, and Treatment. Semin Ophthalmol 2022; 37:801-812. [PMID: 35587465 DOI: 10.1080/08820538.2022.2075706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Aqueous deficiency dry eye disease is a chronic and potentially sight-threatening condition, that occurs due to the dysfunction of the lacrimal glands. The aim of this review was to describe the various recent developments in the understanding, diagnosis and treatment of lacrimal gland insufficiency in aqueous deficiency dry eye disease. METHODS A MEDLINE database search using PubMed was performed using the keywords: "dry eye disease/syndrome", "aqueous deficient/deficiency dry eye disease", "lacrimal gland" and "Sjogren's syndrome". After scanning through 750 relevant abstracts, 73 eligible articles published in the English language from 2016 to 2021 were included in the review. RESULTS Histopathological and ultrastructural studies have revealed new insights into the pathogenesis of cicatrising conjunctivitis-induced aqueous deficiency, where the lacrimal gland acini remain uninvolved and retain their secretory property, while significant ultrastructural changes in the gland have been observed. Recent advances in diagnosis include the techniques of direct clinical assessment of the lacrimal gland morphology and secretion, tear film osmolarity, tear film lysozyme and lactoferrin levels, tear film interferometry and lacrimal gland confocal microscopy. Developments in the treatment of aqueous deficiency dry eye disease, apart from the nanoparticle-based tear substitutes, include secretagogues like diquafosol tetrasodium and rebamipide, anti-inflammatory topical agents like nanomicellar form of cyclosporine and lifitegrast, scleral contact lenses, neurostimulation, and acupuncture for increasing the amount of tear production, minor salivary gland transplantation, faecal microbial transplantation, lacrimal gland regeneration and mesenchymal stem cell therapy. CONCLUSIONS Significant advances in the understanding, diagnosis and management of lacrimal gland insufficiency and its role in aqueous deficiency dry eye disease have taken place within the second half of the last decade. Of which, translational breakthroughs in terms of newer drug formulations and regenerative medicine are most promising.
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Affiliation(s)
- Mariya B Doctor
- Academy of Eye Care Education, L V Prasad Eye Institute, Hyderabad, India.,The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Sayan Basu
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
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24
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Colarusso BA, Bligdon SM, Ganjei AY, Kwok A, Brocks D, Luo ZK. Ocular Graft-versus-Host Disease Underdiagnosis: A Survey Study. Clin Ophthalmol 2022; 16:1419-1426. [PMID: 35535126 PMCID: PMC9078442 DOI: 10.2147/opth.s359539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/21/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
| | | | - Allen Y Ganjei
- Drexel University College of Medicine, Philadelphia, PA, USA
| | | | | | - Zhonghui K Luo
- Massachusetts Eye and Ear, Boston, MA, USA
- Correspondence: Zhonghui K Luo, Massachusetts Eye and Ear, 800 Huntington Avenue, Boston, MA, 02115, USA, Tel +1-617-936-6092, Fax +1-617-936-6186, Email
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25
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Hiratsuka R, Shimizu E, Yamane M, Yazu H, Sato S, Fukui M, Mukai S, Uchino M, Kamoi M, Tatematsu Y, Saijo Y, Negishi K, Tsubota K, Ogawa Y. A single institute validation study comparing the international chronic ocular graft-versus-host disease consensus group diagnostic criteria with clinical parameters. Ocul Surf 2021; 24:12-14. [PMID: 34933116 DOI: 10.1016/j.jtos.2021.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/25/2021] [Accepted: 12/16/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Ryo Hiratsuka
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; Department of Ophthalmology, National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Eisuke Shimizu
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
| | - Mio Yamane
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Yazu
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; Department of Ophthalmology, Tsurumi University School of Dental Medicine, Kanagawa, Japan
| | - Shinri Sato
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Masaki Fukui
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Shin Mukai
- Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Massachusetts, USA
| | - Miki Uchino
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Mizuka Kamoi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Yukako Tatematsu
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Yumiko Saijo
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; Tsubota Laboratory, Inc., Tokyo, Japan
| | - Yoko Ogawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
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