Phacoemulsification in patients after allogeneic bone marrow transplantation.
OBJECTIVE
To study the outcomes of phacoemulsification in allogeneic bone marrow transplant (allo-BMT) recipients.


METHODS
Retrospective, noncomparative, interventional case series.


METHODS
Retrospective study of 34 eyes of 19 consecutive patients who had visually significant cataracts after allo-BMT and subsequently underwent phacoemulsification.


METHODS
Best-corrected vision at the last follow-up visit and development of postoperative complications.


RESULTS
Surgery was done at a mean interval of 37 months after BMT, and the mean postoperative follow-up was 13 months. Twenty-one eyes (62%) had subnormal Schirmer I scores as a result of graft-versus-host disease (GVHD) involving the lacrimal gland. Of these, 71% (15 eyes) additionally had significant ocular surface epitheliopathy because of conjunctival GVHD. Frequent lubrication (95%), punctal occlusion (76%), topical steroids (33%), and other topical immunosuppressive therapies (14%) were used to manage GVHD-induced ocular surface disease before cataract surgery. Twelve patients (63%) also received systemic steroids and immunosuppressives. Patients proceeded to surgery only after their ocular surface disease was well controlled. Early postoperative complications included intraocular pressure elevation (three eyes), worsening of dry eye syndrome (two eyes), and corneal thinning (one eye). Posterior capsular opacification (PCO) requiring laser capsulotomy occurred in 44% of eyes. In eyes with preoperative conjunctival GVHD, 47% had recurrence with cessation of immunosuppressive therapy after surgery. Visual acuity at last follow-up visit was 20/30 or better in 33 (97%) eyes.


CONCLUSIONS
Phacoemulsification is an effective procedure in restoring vision in patients who have cataracts develop after BMT. However, coexisting ocular disease must be recognized and aggressively treated both before and after surgery to ensure good visual outcomes.
Balaram
M
M
Massachusetts Eye and Ear Associates, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Dana
M R
MR
D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002386:Cataract / Q000209:etiology / Q000628:therapy*; D003229:Conjunctival Diseases / Q000209:etiology / Q000628:therapy; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000628:therapy; D006801:Humans; D007431:Intraoperative Complications; D007766:Lacrimal Apparatus Diseases / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D014792:Visual Acuity