Ocular surface and corneal subbasal nerve plexus changes in ocular graft versus host disease patients treated with topical cyclosporine

To investigate the effect of topical cyclosporine (0.05%) on the ocular surface and corneal sub-basal nerve plexus in patients with chronic Ocular Graft-versus-Host Disease (oGVHD). This prospective study included 24 eyes from 24 patients with chronic oGVHD. All patients were treated twice daily with topical cyclosporine (0.05%). Ophthalmic examinations were performed at baseline and at the 1st, 3rd, and 6th months of treatment, including the evaluation of corneal fluorescein staining (CFS).The Ocular Surface Disease Index (OSDI) questionnaire was administered. Non-invasive tear break-up time (NIBUT) (Sirius, CSO, Italy), central corneal epithelial thickness (ET) (AS-OCT, Topcon 3D OCT-1 Maestro, Japan), upper eyelid non-contact meibography (Sirius, CSO, Italy), and in vivo confocal microscopy (ConfoScan4, Nidek, Japan) measurements were performed.A paired t-test was used for comparative analysis. Significant improvements were observed in CFS, NIBUT, and OSDI scores at the 1st, 3rd, and 6th months, as well as in upper eyelid meiboscores at the 3rd and 6th months compared to baseline (p < 0.05).However, no significant changes were found in ET, corneal sub-basal nerve fiber density, nerve fiber count, or fiber tortuosity throughout the study period (p > 0.05). While topical cyclosporine significantly improved the ocular surface and symptoms in patients with oGVHD, it did not alter the morphology of the corneal sub-basal nerve plexus. Its anti-inflammatory effects were evident at the epithelial level, but the treatment did not appear to affect the subepithelial region in the short term. Further research is needed to assess the long-term impact of topical cyclosporine on corneal innervation.