title: Outcomes of cataract surgery in graft-versus-host disease.
abstract: OBJECTIVE
  To study the outcomes of cataract surgery in patients with graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (HSCT).
  
  
  METHODS
  Retrospective review of 72 eyes of 41 patients (age, 17-69 years at the time of surgery) 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), responses to Ocular Surface Disease Index (OSDI) questionnaire, dry eye severity, and postoperative complications.
  
  
  RESULTS
  BCVA improved from 20/49 to 20/25 (P < 0.0001) after surgery. Eight patients (20%) had pretransplantation total body irradiation and 39 patients (95%) 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, subjective OSDI responses and dry eye disease (DED) did not change significantly from before cataract surgery, although OSDI showed a trend toward worsening.
  
  
  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 preexisting ocular surface disease is frequent, and despite meticulous postoperative maintenance therapy, vision-threatening complications may occur.
authors.affiliation: *Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI; †Department of Ophthalmology, Cornea and External Disease Division, Santa Casa de Misericórdia, São Paulo, Brazil; and ‡Beijing Ophthalmic and Visual Science Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, Beijing, China.
authors.forename: Rafael
authors.initials: R
authors.lastname: de Melo Franco
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Kron-Gray
authors.forename: Paola
authors.initials: P
authors.lastname: De la Parra-Colin
authors.forename: Yan
authors.initials: Y
authors.lastname: He
authors.forename: David C
authors.initials: DC
authors.lastname: Musch
authors.forename: Shahzad I
authors.initials: SI
authors.lastname: Mian
authors.forename: Leslie
authors.initials: L
authors.lastname: Niziol
authors.forename: H Kaz
authors.initials: HK
authors.lastname: Soong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002386:Cataract / Q000209:etiology*; D002908:Chronic Disease; D015352:Dry Eye Syndromes / Q000209:etiology / Q000628:therapy; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006086:Graft vs Host Disease / Q000209:etiology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018918:Phacoemulsification; D011183:Postoperative Complications; D012189:Retrospective Studies; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D014792:Visual Acuity / Q000502:physiology; D014916:Whole-Body Irradiation
chemical_list: D005938:Glucocorticoids