Incidence, risk factors, and clinical outcomes of cataracts following hematopoietic stem cell transplantation

Abstract

To evaluate the characteristics of cataracts following hematopoietic stem cell transplantation (HSCT), 561 patients without any ocular complications before HSCT were reviewed. Ocular complications occurred in 196 patients (34.9%). Cataract was diagnosed in 45 of 561 patients. The 10-year estimated cataract incidence was 14%. The median onset time was 498 days after transplant (range, 38-4,535 days). The onset of cataracts was later than that of other ocular complications. Phacoemulsification was performed in 13 patients (29%) at a median of 1,028 days after HSCT (range, 375-4,549 days). In 6 of 13 patients (46%) who underwent cataract surgery, visual acuities gradually deteriorated because of the development of posterior capsule opacification. YAG (yttrium-aluminum-garnet) laser posterior capsulotomy successfully recovered their sight without any sequelae. A multivariate analysis revealed that age, acute and chronic graft versus host disease (GVHD), and systemic infection were significant risk factors for cataract, whereas neither steroid nor total body irradiation (TBI)-containing regimens affected the development of cataract. Our results showed that the clinical outcomes of cataract after HSCT are favorable and comparable to those in the general population. Hyperfractionated TBI with eye shielding may be effective for the prevention of cataract.Numerous advances in allogeneic hematopoietic stem cell transplantation (HSCT) techniques have improved recipients' long-term survival. Currently, patients with acute leukemia or chronic myeloid leukemia who survive without recurrent malignancy for 2 years after allogeneic HSCT have an 89% probability of surviving for at least 5 years, and recently, the quality of life (QOL) of such long-term survivors has been investigated [1]. Several reports revealed that a significantly large population of patients developed ocular complications [2,3], such as cataract, dry eye, retinal bleeding, or intraocular infection, and some of these complications affected patients' QOL. Although cataract formation is one of the major late complications following HSCT, its risk factors are still controversial. Previous reports showed that total body irradiation (TBI) increased the risk of cataract, and single dose TBI was more cataractogeneic than hyperfractionated TBI [4]. In the largest series evaluating a cohort of 1,064 patients, risk factors for the development of cataract were older age, higher dose rate (>0.04 Gy/min), allogeneic HSCT, and steroid administration [5].Recently, hyperfractionated TBI has become one of the widespread standard precautions for HSCT-associated complications, and lens protection with custom-made shielding blocks for each patient is also expected to decrease the incidence of cataracts following HSCT [6,7]. Furthermore, cataract surgery has recently become a low-risk procedure and improves visual acuity in more than 90% of eyes in normal healthy subjects [8][9][10][11] but the long-term outcome of surgical repair in patients who undergo HSCT remains to be clarifi...

Non-GVHD ocular complications after hematopoietic cell transplantation: expert review from the Late Effects and Quality of Life Working Committee of the CIBMTR and Transplant Complications Working Party of the EBMT

“…In addition to TBI, prolonged steroid therapy, such as for treatment of GVHD, has been identified as an independent risk factor for cataracts after HCT. 13,14 A population-based study showed that even inhaled corticosteroids were associated with the development of posterior subcapsular and nuclear cataracts. 15 Survivors of allogeneic HCT are more likely to develop cataracts, when compared with those of autologous HCT.…”

“…The most commonly reported ocular toxicity of anti-cancer drugs is keratoconjunctivitis. Systemic corticosteroids accelerate cataract formation 13,14,85 and glaucoma development. 66 Topical corticosteroids are commonly used for treatment of ocular GVHD, but their long-term use is associated with elevated intraocular pressure, decreased epithelial healing, infection and cataracts.…”

Non-Graft-versus-Host Disease Ocular Complications after Hematopoietic Cell Transplantation: Expert Review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and the Transplant Complications Working Party of the European Society for Blood and Marrow Transplantation

“…Along with TBI, prolonged steroid therapy, such as for treatment of GVHD, has been identified as an independent risk factor for cataracts after HCT [13,14]. A population-based study showed that the use of even inhaled corticosteroids was associated with the development of posterior subcapsular and nuclear cataracts [15].…”

“…The most commonly reported ocular toxicity of anti-cancer drugs is keratoconjunctivitis. Systemic corticosteroids accelerate cataract formation [13,14,85] and glaucoma development [66]. Topical corticosteroids are commonly used for treatment of ocular GVHD, but their long-term use is associated with elevated intraocular pressure, decreased epithelial healing, infection, and cataracts [18].…”

Klinik der okulären Graft-versus-Host Disease

“…Als weitere okuläre Komplikationen nach allogener HSCT entwickeln bis zu 85 % der Patienten eine (meist subkapsuläre) Katarakt, die rasch progredient sein kann und durch die Steroidtherapie und ggf. auch Radiatio bedingt ist [22,23]. Seltener kommt es im Verlauf zu einer steroidinduzierten okulären Hypertension.…”