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

Abstract

Non-graft-versus-host disease (GVHD) ocular complications are generally uncommon after hematopoietic cell transplantation (HCT) but can cause prolonged morbidity affecting activities of daily living and quality of life.Here we provide an expert review of non-GVHD ocular complications in a collaboration between transplantation physicians and ophthalmologists through 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 of Blood and Marrow Transplantation. Complications discussed in this review include cataracts, glaucoma, ocular infections, ocular involvement with malignancy, ischemic microvascular retinopathy, central retinal vein occlusion, retinal hemorrhage, retinal detachment and ocular toxicities associated with medications. We summarize the incidence, risk factors, screening, prevention, and treatment of individual complications and generate evidence-based recommendations. Baseline ocular evaluation before HCT should be considered in all patients who undergo HCT. Follow-up evaluations should be considered according to clinical signs and symptoms and risk factors. Better preventive strategies and treatments remain to be investigated for individual ocular complications after HCT. Both transplantation physicians and ophthalmologists should be knowledgeable about non-GVHD ocular complications and provide comprehensive collaborative team care.

Early Prediction of Cardiovascular Risk after Hematopoietic Cell Transplantation: Are We There Yet?

“…Although peripheral arterial disease has been considered a CV event in HCT recipients [46], measurement of the anklebrachial index has not been reported in this population. Similarly, ischemic microvascular retinopathy has been recognized as a non-GVHD ocular complication in HCT recipients that needs to be prevented by treating CV risk factors [47]. However, [52], the presence of microalbuminuria has been seldom reported.…”

Augenbeteiligung bei Graft-versus-Host-Erkrankung

“…Intraokuläre Beteiligung sieht man i. d. R. im Rahmen der chronischen okulären GVHD nicht; eine retinale Beteiligung wurde im Rahmen einer zerebralen GVHD beschrieben [19]. Insbesondere als Folge der Steroidtherapie sind auch Komplikationen wie Katarakt, okuläre Hypertension und Glaukom möglich [20].…”

“…Intraocular involvement is generally not observed in the con-text of chronic ocular GVHD; retinal involvement has been described in the context of cerebral GVHD [19]. Complications such as cataracts, ocular hypertension, and glaucoma have also been reported, particularly following steroid therapy [20].…”

“…The literature reports that 11 % to 100 % of adults and 4 % to 76 % of children develop cataracts following allogeneic HCT, due to the implementation of steroids, chemotherapy and radiotherapy [20,51]. In the context of cataract operations, postoperative worsening of keratopathy, corneal melting, and even perforation may occur [52].…”

Massive periorbital edema following hematopoietic stem cell transplantation

“…The most frequent ocular complication of autologous hematopoietic stem cell transplantation is opportunistic infection of the ocular adnexa, cornea, vitreous, or retina, occurring during the period of extreme neutropenia before engraftment. 5 Ischemic retinopathy has also been reported. 6 We describe here a case of severe bilateral periorbital edema in a patient after hematopoietic stem cell transplant for neuroblastoma.…”