Bilateral corneal ulceration in ocular graft-versus-host disease
A 53-year-old man presented complaining of dryness, redness, photophobia, and fluctuating visual acuity that began shortly after he underwent cataract surgery. The patient’s medical history was significant for ALL, necessitating allogeneic HSCT that resulted in ocular GVHD. At presentation, ocular examination revealed a 4.5 × 9.0 mm inferocentral area of stromal thinning in the patient’s left (first) eye. The affected eye was treated with lubricating eye drops, prophylactic antibiotics, corticosteroids, and a sutureless amniotic membrane. However, the corneal ulceration perforated, necessitating penetrating keratoplasty with temporal tarsorrhaphy. The patient returned 1 year later, reporting a decrease in visual acuity, ocular pain, and redness. Ocular examination revealed a 3.5 × 2.2 mm paracentral area of stromal thinning in the same (first) eye. The patient was treated with lubricating eye drops, prophylactic antibiotics, corticosteroids, and a therapeutic contact lens. The ulcer resolved over the next several weeks, leaving behind a small scar with thinning and neovascularization. The patient returned several weeks later, complaining of irritation and blurred vision. Ocular examination revealed a 2.2 mm2 area of stromal thinning in the right (second) eye. The patient was treated with lubricating eye drops, prophylactic antibiotics, corticosteroids, and a therapeutic contact lens. The corneal ulceration in the patient’s right (second) eye resolved. However, the patient returned with another corneal perforation in his left (first) eye located in an area of residual thinning. Corneal glue was placed, and a therapeutic penetrating keratoplasty was performed. At the patient’s last follow-up visit, his best corrected visual acuity (BCVA) was 20/30 in his right eye and 20/400 in his left eye.