1. Bilateral Corneal Trophic Ulcers and Subsequent Infectious Keratitis in a Patient with Graft-versus-host Disease Yonca Aydın Akova, MD Bayındır Hospital, Ankara, Turkey

2. Financial interest Alcon, Allergan, Bausch& Lomb, Thea, Deva

3. Purpose To report the clinical picture, complications and therapeutic approach in a patient with chronic graft versus host disease (GVHD)

4. Case Presentation 54-year-old men with chronic myeloid leukemia Bone marrow transplantation He developed chronic GVHD – Severe dry eye, Schirmer test without anesthesia 1 mm, OU – Bilateral trophic corneal ulcers involving the whole cornea – Crystalline keratopathy in the right eye

5. Therapy Topical therapy – Autologous serum 50 % – Unpreserved topical steroids 3x1 – Topical cyclosporine A, 0.05% 4x1 – Unpreserved artificial tears 8x1 Therapeutic soft contact lenses Silicone punctum plugs Systemic therapy – Doxycyline – Prednisolone – Immunosuppressive therapy (mycofenolate and cyclosporine ) – Photopheresis

6. Clinical Findings Bacterial ulcer with hypopyon in the left eye Conjunctival and corneal cultures negative Response to topical fortified vancomycine and ceftazidime therapy Bacterial keratitis with hypopyon

7. Clinical Findings One months later Multiple corneal infiltrates, OD Cultures were positive for candida albicans Response to topical amphotericin B and topical voriconazole 1% therapy Candida keratitis with multiple infiltrates

8. Clinical Findings Infectious crystalline keratopathy and satellite infiltrates caused by candida albicans in the right eye Satellite infiltrates After Treatment

9. Clinical Findings Response to topical amphotericin B and topical voriconazole 1% therapy After Treatment

10. Conclusions Patients with chronic GVHD may develop severe inflammatory changes in the ocular surface – Severe dry eye – Persistent trophic ulcers – Infectious keratitis Bacterial keratitis Fungal keratitis

11. Conclusions Crystalline keratopathy may develop due to corneal infections Microbial causes include not only bacteria but fungi as well GVHD patients should be carefully evaluated for such severe complications in order to start the appropriate treatment timely