Cataract after total body irradiation and bone marrow transplantation: degree of visual impairment.
OBJECTIVE
To assess the degree of visual impairment as a result of cataract formation after total body irradiation (TBI) for bone marrow transplantation.


METHODS
The data from 93 patients who received TBI in 1 or 2 fractions as a part of their conditioning regimen for bone marrow transplantation were analyzed with respect to the degree of visual impairment as a result of cataract formation. The probability to develop severe visual impairment (SVI) was determined for all patients, and the degree of visual impairment was assessed for 56 patients with stabilized cataract, using three categories: no, mild, or severe.


RESULTS
For all 93 patients, the probability of developing a cataract causing SVI was 0.44. For allogeneic patients, it was 0.33 without and 0.71 with steroid treatment (p <0.001). All SVI-free probability curves reached a plateau distinct from the cataract-free curves. Apparently, cataracts developing late in the follow-up period rarely cause SVI. Of the patients with stabilized cataract, 32% had no visual impairment, 16% had mild, and 52% severe impairment. No or mild visual impairment was present in 61% of all patients with stable cataract and no steroid treatment compared with only 13% of the patients treated with steroids (p = 0.035).


CONCLUSIONS
SVI occurs in only some of the patients (52%) with stable cataract after TBI for bone marrow transplantation in 1 or 2 fractions. Steroid treatment markedly increases the probability of developing visual problems as result of a cataract after TBI.
van Kempen-Harteveld
M Loes
ML
Department of Radiotherapy, University Medical Center Utrecht, The Netherlands. M.L.vankempen@radcl.ruu.nl
Struikmans
Henk
H
Kal
Henk B
HB
van der Tweel
Ingeborg
I
Mourits
Maarten P
MP
Verdonck
Leo F
LF
Schipper
Jan
J
Battermann
Jan J
JJ
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D002386:Cataract / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007938:Leukemia / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011336:Probability; D013256:Steroids / Q000627:therapeutic use; D019172:Transplantation Conditioning / Q000009:adverse effects*; D014786:Vision Disorders / Q000209:etiology*; D014916:Whole-Body Irradiation / Q000009:adverse effects*
D013256:Steroids