Cataract after allogeneic hematopoietic stem cell transplantation in childhood.
OBJECTIVE
The aim of this study was to study long-term visual outcome and cataract development in children and adolescents after hematopoietic stem cell transplantation (HSCT) in childhood.


METHODS
Best corrected visual acuity (BCVA), refraction and lens status were examined in a prospective study of 139 children and adolescents.


RESULTS
In total, 139 patients (58 female), median age 6.6 years at HSCT (range 0.4-17.5 years), were followed up for a median of 8.0 years (1-19.4 years). Median BCVA in the better eye was 1.0 decimal. Altogether 19 of 131 patients developed cataract requiring surgery, while 46 developed less prominent lens opacities and 66 had clear lenses at time of latest follow-up. Patients conditioned with total body irradiation had a higher risk of developing lens opacities or cataract (p < 0.0001) as did patients with malignant disease, irrespective of irradiation treatment (p < 0.0001). Cumulative analysis showed that 50% of all patients had developed lens opacities/cataract after 10.2 years. Patients who ultimately needed cataract surgery developed cataract earlier than others (p = 0.006).


CONCLUSIONS
Lens opacities or cataract were more common in children or adolescents with malignant disease and after conditioning with irradiation. Regular ophthalmological follow-up is important after HSCT for early intervention to avoid amblyopia.
Department of Clinical Neuroscience, Karolinska Institutet, St Erik Eye Hospital, Karolinska University Hospital, Huddinge, Stockholm, Sweden.|Department of Ophthalmology, Vrinnevi Hospital, Norrköping, Sweden.
Kristina
K
Teär Fahnehjelm
Department of Clinical Neuroscience, Karolinska Institutet, St Erik Eye Hospital, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
Alba Lucia
AL
Törnquist
Department of Clinical Neuroscience, Karolinska Institutet, St Erik Eye Hospital, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
Monica
M
Olsson
Institute of Neuroscience and Physiology/Ophthalmology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Ingrid
I
Bäckström
Institute of Neuroscience and Physiology/Ophthalmology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Marita
M
Andersson Grönlund
Department of Paediatrics, Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Huddinge, Stockholm, Sweden.|Department of Clintec, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
Jacek
J
Winiarski
D000293:Adolescent; D002386:Cataract / Q000175:diagnosis / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D055815:Young Adult
Cataract; Hematopoietic stem cell transplantation; Total body irradiation; Visual outcome