Bilateral corneal ulceration in ocular graft-versus-host disease
A 59-year-old woman presented complaining of dryness and irritation. The patient’s past medical history was significant for CML treated with allogeneic HSCT that resulted in ocular GVHD. Ocular examination revealed a 1.0 × 1.1 mm inferonasal epithelial defect with stromal thinning without any signs of infection in her right (first) eye. The patient was treated with lubricating eye drops, prophylactic antibiotics, corticosteroids, and a therapeutic contact lens. The corneal ulceration healed over the next several months, leaving behind minimal residual thinning. Shortly thereafter, the patient returned with a 1 mm2 area of stromal thinning in her left (second) eye. In addition to the standard therapy, she was prescribed topical anakinra (Kineret®; Swedish Orphan Biovitrum, Stockholm, Sweden), and her signs and symptoms resolved with minimal residual thinning. The patient’s BCVA was 20/30 in her right eye and 20/30 in her left eye at her last follow-up visit.