Outcomes of Cataract Surgery in Graft-Versus-Host Disease

Abstract

Purpose: To study cataract surgery outcomes in patients with graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (HSCT).

Methods: Retrospective review of 71 eyes of 42 patients 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), Ocular Surface Disease Index (OSDI) questionnaire responses, dry eye severity, and postoperative complications.

Results: The BCVA improved from 20/49 to 20/25 (p<0.0001) after surgery. Eight patients (19%) had pre-transplantation total body irradiation and 39 (93%) 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, the subjective OSDI responses did not change significantly, but clinically the dry eye disease (DED) became worse in 22 eyes (p=0.019).

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 pre-existing ocular surface disease is frequent, and despite meticulous postoperative maintenance therapy, vision-threatening complications may occur.

Keywords: 445 cataract