@article {1307451,
	title = {Reduced Efficacy of Low-dose Topical Steroids in Dry Eye Disease Associated With Graft-versus-Host Disease},
	journal = {Am J Ophthalmol},
	volume = {190},
	year = {2018},
	month = {2018 Jun},
	pages = {17-23},
	abstract = {PURPOSE: To compare the response of dry eye disease (DED) to treatment with topical steroid in patients with and without graft-vs-host disease (GVHD).

DESIGN: Post hoc analysis of a double-masked, randomized clinical trial.

METHODS: This single-center study included 42 patients with moderate-to-severe DED associated with (n~= 21) or without (n~= 21) chronic GVHD. In each group, patients received either loteprednol etabonate 0.5\% ophthalmic suspension or artificial tears twice daily for 4~weeks. Clinical data, including Ocular Surface Disease Index (OSDI) questionnaire, corneal fluorescein staining (CFS), conjunctival lissamine green staining, tear break-up time (TBUT), and Schirmer test, were evaluated before and after treatment.

RESULTS: There were no significant differences in signs and symptoms of DED between the groups at baseline. In non-GVHD patients receiving loteprednol treatment, the average OSDI score decreased by 34\% from 49.5 {\textpm} 5.9 to 32.6 {\textpm} 4.8 (mean {\textpm} standard error of the mean, P~= .001) and the average CFS score decreased by 41\% from 5.6 {\textpm} 0.6 to 3.3 {\textpm} 0.9 (P~= .02). On the other hand, loteprednol treatment in GVHD patients resulted in minimal change in OSDI (59.2 {\textpm} 6.7 to 61.1 {\textpm} 7.1, 3\% increase, P~= .66) and CFS (5.5 {\textpm} 0.5 to 5.3 {\textpm} 1.1, 4\% decrease, P~= .85) scores. Treatment with artificial tears resulted in 22\% decrease of OSDI (P~= .10) and 32\% decrease of CFS (P~= .02) scores in non-GVHD patients, and had minimal effect in patients with GVHD.

CONCLUSIONS: DED patients with ocular GVHD have a less favorable response to a low-dose topical steroid regimen compared with those without ocular GVHD even with similar baseline disease severity.},
	issn = {1879-1891},
	doi = {10.1016/j.ajo.2018.03.024},
	author = {Yin, Jia and Kheirkhah, Ahmad and Dohlman, Thomas and Saboo, Ujwala and Dana, Reza}
}
