Purchase this article with an account.
Ariel Chen, Kimberly G Yen; Outcome of cataract surgery in children after bone marrow transplantation. Invest. Ophthalmol. Vis. Sci. 2017;58(8):779.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Pediatric cataracts are known to develop in patients who have received bone marrow transplantation (BMT) and pre-treatment conditioning such as total body irradiation (TBI). We present the outcome of cataract surgery in children who have undergone BMT.
Retrospective chart study involving 15 patients (28 eyes) with a history of BMT who had cataract extraction between 2002 and 2012. Outcome measures include change in visual acuity and complications.
Of the 15 patients, 7 (47%) had acute lymphoid leukemia, 3 (20%) had acute myeloid leukemia, 2 (13%) had myelodysplastic syndrome, 1 (7%) had Fanconi anemia, 1 (7%) had juvenile myelomonocytic leukemia, and 1 (7%) had adrenoleukodystrophy. All patients received BMT and conditioning chemotherapy at a mean age of 47.2 ± 19.2 months. Six patients (40%) were female and 9 (60%) were male. Twelve (43%) patients received TBI and 3 (14%) received cranial irradiation in addition to TBI; one (4%) received only cranial irradiation. Eight (53%) patients developed graft versus host disease treated with prednisone and immunomodulators. Mean age of cataract surgery was 109.3 ± 27.1 months; mean follow-up was 55.9 ± 45.1 months. All cataracts were posterior subcapsular subtype. Mean visual acuity improved from 0.7 ± 0.4 logMAR pre-op to 0.3 ± 0.5 logMAR at last visit, p < 0.001. 23/28 eyes (80%) had cataract extraction with intraocular lens placement; 5/28 (20%) of the eyes had cataract extraction with primary posterior capsulotomy and anterior vitrectomy (PC/AVx). 23/23 of the eyes that did not have primary PC/AVx developed PCO; 21 of the 23 eyes (91%) were noted to have posterior capsular opacification (PCO) intraoperatively with inability to completely polish the capsule. 19 (80%) of these were visually significant and 16 of these eyes received YAG laser treatment a mean of 13.4 ± 31.4 months after cataract surgery. Of the remaining visually significant PCO, one belonged to a deceased patient and the other two were lost to follow-up. None of the primary PC/AVx eyes developed PCO.
Children with history of BMT have a predisposition of developing posterior subcapsular cataracts. Need for YAG laser or treatment for PCO is high in this population due to the type of cataracts they develop. The incidence of postoperative PCO treatment is significantly reduced in patients who have primary posterior capsulotomy and anterior vitrectomy.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
This PDF is available to Subscribers Only