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Outcomes of cataract surgery in graft-versus-host disease
Rafael de Melo Franco1, Michelle M Kron-Gray, Paola De la Parra-Colin
1*Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI; †Department of Ophthalmology, Cornea and External Disease Division, Santa Casa de Misericórdia, São Paulo, Brazil; and ‡Beijing Ophthalmic and Visual Science Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, Beijing, China.
Insights
Cataract surgery in patients with graft-versus-host disease (GVHD) after stem cell transplant leads to improved vision. However, careful management of dry eye disease is crucial to prevent vision-threatening complications.
Area of Science:
- Ophthalmology
- Hematology
- Transplantation Medicine
Background:
- Graft-versus-host disease (GVHD) is a common complication following allogeneic hematopoietic stem cell transplantation (HSCT).
- Cataract formation can occur in patients with GVHD, impacting visual function.
Purpose of the Study:
- To evaluate the visual outcomes and complications of cataract surgery in patients with chronic GVHD post-HSCT.
Main Methods:
- Retrospective review of 72 eyes from 41 patients with chronic GVHD who underwent cataract surgery.
- Data collected included visual acuity, Ocular Surface Disease Index (OSDI), dry eye severity, and complications.
Main Results:
- Best-corrected visual acuity (BCVA) significantly improved post-surgery (20/49 to 20/25, P < 0.0001).
- Complications included cystoid macular edema and corneal ulceration.
- Dry eye disease and OSDI scores showed no significant change, with a trend toward worsening OSDI.
Conclusions:
- Cataract surgery offers good visual outcomes in GVHD patients with proper management of ocular surface disease.
- Aggravation of pre-existing ocular surface disease is common, and vision-threatening complications can occur despite management.
Purpose:
To study the outcomes of cataract surgery in patients with graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (HSCT).
Methods:
Retrospective review of 72 eyes of 41 patients (age, 17-69 years at the time of surgery) with chronic GVHD after HSCT, who underwent cataract surgery between 2008 and 2012 at the Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan. Ophthalmic data collected included best-corrected visual acuity (BCVA), responses to Ocular Surface Disease Index (OSDI) questionnaire, dry eye severity, and postoperative complications.
Results:
BCVA improved from 20/49 to 20/25 (P < 0.0001) after surgery. Eight patients (20%) had pretransplantation total body irradiation and 39 patients (95%) received systemic corticosteroids for the treatment of GVHD. Postoperative complications included cystoid macular edema (4 eyes), corneal ulceration with perforation (2 eyes: 1 infected and 1 sterile), and band keratopathy (1 eye). After surgery, subjective OSDI responses and dry eye disease (DED) did not change significantly from before cataract surgery, although OSDI showed a trend toward worsening.
Conclusions:
With careful monitoring and management of DED and concurrent ocular surface disease, cataract surgery generally has good visual outcomes in patients with GVHD. However, aggravation of the preexisting ocular surface disease is frequent, and despite meticulous postoperative maintenance therapy, vision-threatening complications may occur.
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