Late ocular complications after bone marrow transplantation

The most usual late ocular complications after bone marrow transplantation (BMT) are the microvasculopathy in the ocular fundus, the cataract formation and the keratoconjunctivitis sicca syndrome. Microvascular lesions in the eye fundus were evaluated in 127 patients treated at the University Hospital of Basel, Switzerland and appeared to be cotton wool spots, retinal hemorrhages, edema of the optic disk and retinal lipoid deposits. 13 of the 127 patients (10.3%) developed ischemic lesions of the fundus 3 to 6 months after BMT. Microvasculopathy was observed exclusively in patients conditioned with total body irradiation (TBI) and treated with cyclosporine A for graft-versus-host disease (GvHD). It is therefore likely that both factors are needed for the development of the microvasculopathy and we believe that lesions observed in the fundus are not restricted to the eye but reflect a generalized process of the capillary system. Cataract formation was evaluated in 197 patients treated at the University Hospital of Basel, Switzerland. 70 of the 197 (36%) patients developed cataract and 46 (23%) patients needed a surgical repair. After single dose TBI, all patients alive at 3.5 years had a lens opacification. In patients treated with fractionated TBI the probability of developing cataract is 29% at 3.5 years but 83% at 6 years. Only 1 of 33 patients conditioned with chemotherapy alone had cataract formation. In conclusion TBI as well as the mode of irradiation are the main risk factors for the development of cataract. Preventive measures, such as lens shielding during TBI should be considered.(ABSTRACT TRUNCATED AT 250 WORDS)