“For your eyes only”: ophthalmic complications following lung transplantation

Abstract

Ophthalmic complications in the lung transplant population are a little-known entity. It includes a spectrum of diseases ranging from infections such as cytomegalovirus (CMV) retinitis, herpetic keratitis, Pseudallescheria boydii to non-infectious complications such as posterior subcapsular cataracts (PSCs), cyclosporine retinopathy, and post-transplant lymphoproliferative disorder (PTLD). These diseases can be attributed to high levels of immunosuppression, advanced age, and drug-specific side effects. Underlying comorbidities such as diabetes mellitus may also play a role in the pathogenesis. Patients can present with varied symptoms such as blurry vision, floaters or eye pain. Prompt diagnosis often requires a high index of suspicion. With increasing numbers of transplants being performed worldwide, it is imperative for the pulmonologist and transplant physician to recognize these often subtle symptoms. Any visual symptom should trigger an ophthalmological evaluation in order to manage these complications; some of which pose the risk of systemic dissemination and significant morbidity. The following article provides an indepth review of the common presenting symptoms, treatments and recent advances related to common ophthalmic complications following lung transplantation. While this article focuses on the lung transplant sub-population, the authors would like to point out that some of these complications are shared by other solid-organ transplants as well, by virtue of their shared immunosuppressive therapies.

Bilateral central retinal/ophthalmic artery occlusion and near-complete ophthalmoplegia after bilateral lung transplant

“…Tarabishy et al found that the most common ocular abnormality following lung transplant was posterior subcapsular cataract, followed by infectious ocular complications 34 . High levels of immunosuppression, advanced age, drug-specific side effects, underlying comorbidities such as diabetes mellitus, have been suggested to play a role in pathogensis 35 . Although visual loss from CPB has been reported previously, to our knowledge there are no prior reports of ophthalmic artery level ischemia presenting with CRAO, AION, and bilateral ophthalmoloplegia in the English language ophthalmic literature.…”

Horner's syndrome following single lung transplantation

“…2,4 Other side effects of central line placement include pneumothorax, traumatic puncture of the thoracic vessels, and even traumatic puncture of intrathoracic organs. 4,5 However, ophthalmic complications are uncommon. While some ophthalmic complications are due to medication side effects, others are attributed to systemic immunosuppression.…”

“…The infectious diseases include cytomegalovirus retinitis, herpetic keratitis, herpes zoster opthalmicus, rhino-orbital mucormycosis, and disseminated pseudallescheria boydii infection. 5 Noninfectious complications can be divided into non-neoplastic vs neoplastic. The non-neoplastic complications can be cyclosporine-induced retinopathy, posterior subcapsular cataract, and central retinal vein occlusion.…”

“…The non-neoplastic complications can be cyclosporine-induced retinopathy, posterior subcapsular cataract, and central retinal vein occlusion. 5 Neoplastic complications include posttransplant lymphoproliferative disorder and squamous cell carcinoma of conjunctiva and eyelids. 5 Horner's syndrome is an uncommon disease that can be acquired, congenital, or purely hereditary.…”

“…5 Neoplastic complications include posttransplant lymphoproliferative disorder and squamous cell carcinoma of conjunctiva and eyelids. 5 Horner's syndrome is an uncommon disease that can be acquired, congenital, or purely hereditary. 1,2 It may develop due to any lesions along the sympathetic pathway causing the following symptoms: ptosis, miosis, anhydrosis.…”