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Ujwala Saboo, Hasanain Shikari, Reza Dana; Cataract Prevalence and Cataract Surgery Outcomes in Patients with Ocular Graft-Versus-Host Disease (GVHD). Invest. Ophthalmol. Vis. Sci. 2013;54(15):3001. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To study the prevalence of cataracts and the outcomes of cataract surgery in patients with ocular GVHD after bone marrow/hematopoietic stem cell transplantation.
Retrospective chart review of 140 patients with ocular GVHD from January 2007- September 2011 was performed.
During the observational period, the overall prevalence of bilateral cataract was 43% (60/140) and unilateral cataract was 3.5% (5/140), while the prevalence of vision impairing cataract requiring surgery was 24% (30/125 eyes with cataract). Eight patients had bilateral pseudophakia at presentation. The mean age at diagnosis of cataract was 53 ±12.5 years (mean ± SD). The index diagnosis of cataract was made at 37±4 months (mean ± SEM) after transplantation. There was an increased risk of cataracts in patients receiving systemic corticosteroids for a duration ≥ 12 months as compared to those receiving corticosteroids <12 months (p=0.022). No significant association was found between cataracts and pre-conditioning with total body irradiation (p=0.38). Ocular surface disease was managed preoperatively with lubricants (100%), punctal occlusion (66%), topical interleukin-1 receptor antagonist (56%), and topical cyclosporine (16%). Stable ocular surface was ensured prior to cataract surgery in all patients. Mean best corrected visual acuity (BCVA) was 20/60 preoperatively and showed significant improvement to 20/30 postoperatively (p=0.0001). Mean follow up after surgery was 17±14 months.
Patients with GVHD have a high prevalence of cataracts. Systemic corticosteroid use for ≥ 12 months significantly increases the risk of cataract formation. Visual outcomes after cataract surgery are generally quite good; however, increased early postoperative surface-related complications need early detection.
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