Retinal complications in patients with solid organ or bone marrow transplantations

The administration of systemic immunosuppressive agents to recipients of solid organ or bone marrow transplants results in an immunocompromised status. As the number of organ recipients and their life span increase with recent progress in organ transplantation, ocular complications tend to become more diverse and serious.

From 1995 to 2005, 3656 cases of organ transplantations were performed at Asan Medical Center. The medical records of 1198 of these patients who had been examined at the Department of Ophthalmology were reviewed.

Retinal complications were diagnosed in 33 of the transplant recipients; five with bone marrow transplantation, 16 with kidney transplantation, seven with liver transplantation (LT), and five with heart transplantation. Diagnoses included 11 cases of CMV (cytomegalovirus) retinitis, three of acute retinal necrosis, one of progressive outer retinal necrosis, five of fungal chorioretinitis, one of toxoplasmic retinochoroiditis, three of central retinal vein occlusion, and nine of central serous chorioretinopathy. While CMV, fungal, or toxoplasmic chorioretinitis developed frequently in association with extraocular infection or organ rejection, herpetic infection manifested only in the eye without any rejection. Most infectious cases responded well to the standard therapeutic regimen. Interestingly, central retinal vein occlusion developed exclusively following LT, possibly in relation to coagulation cascade abnormality.

To our best knowledge, this comprehensive review presents the largest series of ocular complication in organ transplant recipients. Familiarity with the potential ocular complications as well as a high index of suspicion is warranted to the practicing ophthalmologists.