Visual outcome and cataract development after allogeneic stem-cell transplantation in children.
OBJECTIVE
To report visual functions and prevalence of cataract after haematopoetic stem-cell transplantation (SCT) during childhood and to determine the impact of different conditioning regimes and other possible risk factors.


METHODS
Assessment of visual acuity (VA), slit-lamp biomicroscopy of the lenses and examination of the ocular fundii were performed in 79 subjects 2-18 years (median 7 years) after SCT.


RESULTS
Best-corrected decimal VA > or = 0.5 was achieved in 152/158 eyes (96%). There was an increased risk of cataract after conditioning with single-dose total body irradiation (s-TBI) or fractionated TBI (f-TBI) compared to busulfan or other chemotherapy (P < 0.001) and an increased risk of developing cataract earlier if treated with s-TBI compared to f-TBI (P < 0.01). The TBI mode did not affect the time to first surgical intervention. Apart from s-TBI and f-TBI, age was found to be an independent risk factor. Cataract also developed in patients prepared with chemotherapy but no patient required surgery. Neither treatment with steroids for 6 months or longer nor history of chronic graft versus host disease (GVHD) influenced cataract development.


CONCLUSIONS
Conditioning with full dose f-TBI compared to s-TBI postpones but does not prevent cataract or cataract surgery while chemotherapy-based conditioning induces less severe cataracts, usually not requiring surgery. Corticosteroids or GVHD do not appear as risk factors.
Fahnehjelm
Kristina Teär
KT
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. kristin.fahnehjelm@ki.se
Törnquist
Alba-Lucia
AL
Olsson
Monica
M
Winiarski
Jacek
J
D000293:Adolescent; D002386:Cataract / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007223:Infant; D008297:Male; D011183:Postoperative Complications; D015995:Prevalence; D012029:Refraction, Ocular; D042262:Retinoscopy; D012307:Risk Factors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D014792:Visual Acuity / Q000502:physiology*; D014916:Whole-Body Irradiation
D007166:Immunosuppressive Agents