Vol. 7, Issue 2, Part A (2025)

Ocular complications are most prevalent after HSCT and relate to chronic graft-versus-host disease (GVHD), with the development of dry eye disease, destruction of the ocular surface, or corneal melt. The given case study is of a 35-year-old male patient who had acute myeloid leukemia after HSCT in February 2021. The development of serious bilateral dry eye was noted, as chronic GVHD was diagnosed 8 months after the procedure. The initial management technique consisted of preservative-free lubricants, autologous serum eye drop, punctal plugs, and topical steroid, and the patient had the best results over a period of more than one year. In January 2023, the patient complained about soreness in the left eye and blurred vision again. Following further examination, the diagnosis was that the superior limbal keratitis had developed, which is complicated by the corneal thinning and ulceration. Anterior segment optical coherence tomography (OCT) revealed the corneal thickness of 233 microns, equivalent to 50 percent stromal thinning and hence the culmination of corneal melt diagnosis. It was managed with a combination of two treatment modalities; the first management involved systemic corticosteroid therapy (e.g., oral prednisolone 30mg daily, which was tapered gradually to 5mg/week), and the second a topical Lotemax therapy with Loteprednol Etabonate. Corneal melt is more prevalent in patients with chronic ocular GVHD, and thus the importance of early diagnosis and prompt immunosuppressive treatment program cannot be overstated to prevent vision loss.