title: Visual outcome and cataract development after allogeneic stem-cell transplantation in children.
abstract: 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.
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. kristin.fahnehjelm@ki.se
authors.forename: Kristina Teär
authors.initials: KT
authors.lastname: Fahnehjelm
authors.forename: Alba-Lucia
authors.initials: AL
authors.lastname: Törnquist
authors.forename: Monica
authors.initials: M
authors.lastname: Olsson
authors.forename: Jacek
authors.initials: J
authors.lastname: Winiarski
mesh_terms: 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
chemical_list: D007166:Immunosuppressive Agents