Nicht invasive Diagnostik der okulären Graft-versus-Host-Erkrankung

Zusammenfassung

Die okuläre GvHD (Graft-versus-Host Disease) stellt eine häufige Komplikation nach allogener Blutstammzelltransplantation dar. Dabei führen verschiedene Faktoren zu einer milden bis starken Störung der Integrität der Augenoberfläche. Leitsymptom ist dabei das Trockene Auge, welches eine starke inflammatorische Komponente aufweist und in vielen Fällen einen schweren Verlauf, bis hin zu kornealen Ulzerationen, zeigt. Diagnosestellung und Behandlung einer okulären GvHD stellen eine Herausforderung an den Augenarzt dar und erfordern eine intensive Zusammenarbeit mit den hämatoonkologischen Kollegen. Sowohl bei der Erstvorstellung als auch in der Verlaufskontrolle setzt sich die Diagnostik aus einer Vielzahl von Untersuchungen zusammen. Diese beurteilen einerseits sowohl qualitativ als auch quantitativ die Zusammensetzung des Tränenfilms, andererseits werden aber auch subjektive Beschwerden des Patienten mit berücksichtigt. Die zur Verfügung stehenden Tests sind dabei zwar sensitiv für das Vorliegen eines Trockenen Auges, aber relativ unspezifisch für das Vorliegen einer okulären GvHD. Daher lässt nur eine umfassende Zusammenschau der erhobenen Befunde eine endgültige Aussage hinsichtlich des okulären Status zu. Die folgende Übersicht fasst sowohl etablierte als auch innovative, nicht invasive diagnostische Tests zusammen und bewertet diese hinsichtlich einer möglichen Anwendung in der Zukunft.

Abstract

Ocular graft-vs-host disease (GvHD) is a major complication following allogenic blood stem cell transplantation (aBSCT) leading to a disturbance of the ocular surface integrity with a broad range of severity. Leading symptom is a pronounced autoinflammatory reaction in particular at the ocular surface with typical features of dry eye disease. Potential complications include visual loss, pain and damage to the ocular structures with, e. g. corneal ulcerations. Diagnosis and treatment of ocular GvHD are a challenge for attending ophthalmologists and require intensive interdisciplinary patient care in particular with haemato-oncologists. First and follow-up examinations consist of several diagnostic steps that include quantitative and qualitative analysis of tearfilm, visual acuity, ocular surface and retinal integrity, cataract development and subjective symptoms. Available tests are mostly evaluated for usage in dry eye diagnosis but are, however, mostly unspecific for diagnosing ocular GvHD reliably. Only combinations of several clinical tests together with the experience of specialised ophthalmologists may lead to the certain diagnosis and treatment decisions at state. This review illustrates the available established and innovative non-invasive diagnostic tests and evaluates their potential use for diagnosing ocular GvHD.

Schlüsselwörter

Bindehaut - Kornea - Lider - okuläre GvhD (graft-vs-host disease) - Diagnostik

Key words

conjunctiva - cornea - lids - ocular graft-vs-host disease (GvHD) - diagnostics

^* Die beiden Autoren haben eine geteilte Erstautorenschaft.

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