Long-term clinical outcomes in chronic ocular graft-versus-host disease: a retrospective cohort study

Eye (Lond). 2026 Apr 24. doi: 10.1038/s41433-026-04489-y. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic ocular graft-versus-host disease (oGVHD) is a debilitating complication of allogeneic hematopoietic stem cell transplantation (HSCT) that leads to persistent ocular surface damage, visual morbidity, and substantial treatment burden. Despite its prevalence, long-term outcome data remain limited.

METHODS: We conducted a retrospective cohort study of patients evaluated between 2012 and 2024 at a tertiary academic centre in Vancouver, Canada, with follow up of a year or more and recorded the outcomes of the first five years to characterise longitudinal ocular outcomes and therapeutic trajectories in patients with oGVHD.

RESULTS: A total of 189 patients met inclusion criteria. At baseline, meibomian gland dysfunction (81.5%) and superficial punctate keratitis (49.7%) were highly prevalent. Over five years, these manifestations remained persistent in over half of patients, while vision-threatening complications including filamentary keratitis (3.7%), corneal neovascularisation (2.6%), and limbal stem cell deficiency (4.8%) emerged. Therapeutic escalation was common, with 92.1% of patients requiring artificial tears, 47.1% serum tears, 28.0% punctal cautery, 19.0% scleral lenses, and 7.4% topical cyclosporine by year five. Baseline NIH Eye Scores correlated with later complications and treatment intensity, while NIH Lung and Mouth Scores were also predictive of ocular surface disease.

CONCLUSIONS: These findings underscore the progressive, treatment-resistant nature of oGVHD and highlight the value of early ophthalmic referral and multidisciplinary management to preserve vision and quality of life.

PMID:42032052 | DOI:10.1038/s41433-026-04489-y