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Bilateral Corneal Trophic Ulcers and Subsequent Infectious Keratitis in a Patient with Graft-versus-host Disease Yonca Aydın Akova, MD Bayındır Hospital, Ankara, Turkey Financial interest Alcon, Allergan, Bausch& Lomb, Thea, Deva Purpose • To report the clinical picture, complications and therapeutic approach in a patient with chronic graft versus host disease (GVHD) 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 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 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 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 Clinical Findings • Infectious crystalline keratopathy and satellite infiltrates caused by candida albicans in the right eye Satellite infiltrates After Treatment Clinical Findings • Response to topical amphotericin B and topical voriconazole 1% therapy After Treatment 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 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