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Published on: February 15, 2022
Ocular complications in children within 1 year after hematopoietic stem cell transplantation
Viera Kalinina Ayuso1, Ymkje Hettinga, Patricia van der Does
1Department of Ophthalmology, University Medical Center Utrecht, the Netherlands. v.kalininaayuso@umcutrecht.nl
Insights
Ocular complications are common in pediatric hematopoietic stem cell transplantation (HSCT) patients, with 27% experiencing issues like dry eye syndrome. While often mild, vigilance for vision-threatening conditions is advised.
Area of Science:
- Ophthalmology
- Pediatric Hematology
- Stem Cell Transplantation
Background:
- Pediatric hematopoietic stem cell transplantation (HSCT) patients are vulnerable to ocular complications.
- Young patients may not recognize or report vision problems, necessitating proactive monitoring.
Purpose of the Study:
- To investigate the incidence and types of ocular complications within one year post-HSCT in children.
- To identify risk factors associated with ocular involvement after pediatric HSCT.
Main Methods:
- A prospective study involving 49 pediatric patients undergoing HSCT.
- Systematic ophthalmologic evaluations were conducted pre-HSCT and at 3, 6, and 12 months post-HSCT, with additional checks during viral reactivations.
Main Results:
- 27% of patients developed ocular complications, most commonly dry eye syndrome (14%) and retinal hemorrhages (12%).
- Optic disc edema and chorioretinal lesions were also observed.
- Children with malignant diseases showed a higher risk of ocular complications compared to those with non-malignant conditions.
Conclusions:
- Ocular complications are frequent but generally mild in pediatric HSCT recipients.
- While viral uveitis risk is low, the potential for severe vision-threatening complications warrants ongoing surveillance.
Importance:
It is essential to have insights into the risk of ocular involvement after hematopoietic stem cell transplantation (HSCT) in the pediatric population because young and severely ill children are unaware of their ocular problems.
Objective:
To study the development of ocular complications in children within 1 year after HSCT.
Design And Setting:
This prospective study includes all consecutive patients who had undergone an HSCT at the Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands, in 2009 and 2010.
Participants:
Forty-nine consecutive patients underwent systematic ophthalmologic evaluations before HSCT, before leaving the HSCT unit after HSCT, and 3, 6, and 12 months after HSCT. Additional examinations were performed during systemic viral reactivations.
Main Outcome Measure:
Development of ocular complications, including uveitis, hemorrhagic complications, optic disc edema, and dry eye syndrome.
Results:
Thirteen patients (27%) developed an ocular complication after HSCT. These complications included DES (n = 7 [14%]), (sub)retinal hemorrhage (n = 6 [12%]), optic disc edema (n = 3 [6%]), chorioretinal lesions (n = 2 [4%]), vitritis (n = 1 [2%]), and increased intraocular pressure (n = 1 [2%]). Median time to the development of dry eye syndrome was 5 months after HSCT, whereas all other ocular complications were detected within the first 3 months after HSCT. In most cases, the symptoms were mild and self-limiting. Children with malignant disease had a higher risk of the development of ocular complications compared with children with nonmalignant disease.
Conclusions And Relevance:
Ocular complications in pediatric HSCT patients are common, although mostly mild. The risk of viral uveitis development during systemic viral reactivations is low; however, the potential risk of vision-threatening complications in this population cannot be ruled out.
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