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Cataract development and outcome of surgery in bone marrow transplanted children
1Department of Ophthalmology, Karolinska Institute, St Erik's Eye Hospital, Stockholm, Sweden.
Insights
Bone marrow transplant (BMT) patients receiving total body irradiation (TBI) developed posterior subcapsular cataracts (PSC). Cataract extraction improved vision, but laser capsulotomy was often needed. TBI is the likely cause of these cataracts.
Area of Science:
- Ophthalmology
- Hematology
- Pediatric Oncology
Background:
- Bone marrow transplantation (BMT) is a critical treatment for various hematologic conditions.
- Cataract development is a known complication following BMT, particularly in pediatric patients.
- Understanding the specific risk factors and incidence of post-BMT cataracts is crucial for long-term patient care.
Purpose of the Study:
- To prospectively investigate the incidence and characteristics of cataract development in children undergoing BMT.
- To identify potential risk factors, such as conditioning regimens, associated with post-BMT cataracts.
- To evaluate the outcomes of cataract surgery in this patient population.
Main Methods:
- Prospective study of 61 children transplanted before age 18 who survived >1 year post-BMT.
- Patients were grouped based on underlying condition: leukemia (n=43) or severe aplastic anemia (SAA) (n=9).
- Conditioning regimens included cyclophosphamide (Cy) and total body irradiation (TBI) for leukemia, and Cy alone for SAA.
Main Results:
- No cataracts were observed in SAA patients treated with Cy alone.
- All leukemia patients (n=37) followed for ≥3 years developed posterior subcapsular cataracts (PSC).
- Cataract extraction in 28 eyes showed similar postoperative visual acuity, with most requiring laser capsulotomy within 2 years.
Conclusions:
- Total body irradiation (TBI) is strongly implicated as the primary cause of high cataract incidence after BMT.
- Steroid administration's role is unclear but cannot be entirely excluded as a contributing factor.
- While cataract surgery restores vision, subsequent procedures like laser capsulotomy are frequently necessary.
Abstract:
Cataract development in bone marrow transplanted (BMT) patients was studied prospectively. There were 61 children, transplanted before the age of 18 years, who survived more than 1 year after transplantation. Patients transplanted for leukaemia (n = 43) were conditioned before BMT with cyclophosphamide (Cy) and total body irradiation (TBI). Patients with severe aplastic anaemia (SAA) (n = 9) only received Cy. None of the patients with SAA developed cataracts. All children with leukaemia, who were followed for at least 3 years (n = 37), developed lens posterior subcapsular cataracts (PSC). Cataract extraction was performed in 28 eyes, on average 5.1 years (range 3-9 years) after BMT. Postoperative corrected visual acuity was similar to that before BMT. The majority of cases needed laser capsulotomy within 2 years after cataract extraction. TBI seems to be the main cause for the high incidence of cataract after BMT. A relationship to steroid administration could not be proved, but a contributory effect is not excluded.
