Visual outcome and cataract development after allogeneic stem‐cell transplantation in children

Abstract

. Purpose: To report visual functions and prevalence of cataract after haematopoetic stem‐cell transplantation (SCT) during childhood and to determine the impact of different conditioning regimes and other possible risk factors. Methods: Assessment of visual acuity (VA), slit‐lamp biomicroscopy of the lenses and examination of the ocular fundii were performed in 79 subjects 2–18 years (median 7 years) after SCT. Results: Best‐corrected decimal VA ≥ 0.5 was achieved in 152/158 eyes (96%). There was an increased risk of cataract after conditioning with single‐dose total body irradiation (s‐TBI) or fractionated TBI (f‐TBI) compared to busulfan or other chemotherapy (P < 0.001) and an increased risk of developing cataract earlier if treated with s‐TBI compared to f‐TBI (P < 0.01). The TBI mode did not affect the time to first surgical intervention. Apart from s‐TBI and f‐TBI, age was found to be an independent risk factor. Cataract also developed in patients prepared with chemotherapy but no patient required surgery. Neither treatment with steroids for 6 months or longer nor history of chronic graft versus host disease (GVHD) influenced cataract development. Conclusion: Conditioning with full dose f‐TBI compared to s‐TBI postpones but does not prevent cataract or cataract surgery while chemotherapy‐based conditioning induces less severe cataracts, usually not requiring surgery. Corticosteroids or GVHD do not appear as risk factors.

Late effects in children who underwent hematopoietic stem cell transplantation (review)

“…Эти состояния, как правило, связаны с ТОТ, применением бусульфана и глюкокортикостероидов [83]. Синдром сухого глаза встречался в исследованиях не так часто и беспокоил 10-15 % пациентов после ТГСК с раз-витием кератоконъюнктивита [86]. Ухудшение слуха связывают с введением препаратов, препятствующих сшиванию ДНК, и высокими дозами облучения [87].…”

Visual field results and optic disc morphology in patients treated with allogeneic stem-cell transplantation in childhood

“…Demographic data including mean age at SCT, diagnoses and gender from 79 patients have been presented previously (Fahnehjelm et al 2007(Fahnehjelm et al , 2008. Fifty-three patients (27 male and 26 female) with a median age of 15.4 years (range 7.4-20.9) underwent RB visual field examinations, all performed by one of the authors (M.O.).…”

“…In brief, there was an increased risk of cataract after conditioning with single-dose TBI (s-TBI) or fractionated TBI (f-TBI) compared to busulfan or other chemotherapy (p < 0.001) (Fahnehjelm et al 2007). Full dose f-TBI compared to s-TBI postponed but did not prevent cataract or cataract surgery while chemotherapy-based conditioning induced less severe cataracts, usually not requiring surgery (Fahnehjelm et al 2007). Epithelial superficial keratopathy was shown to be more common if the patients were exposed to repeated high trough levels of cyclosporine A (Fahnehjelm et al 2008).…”

Assessing the risk of transplant-related complications and individually tailoring the HSCT procedure in children and adolescents—is it possible?

“…33 Long-term steroid treatment following transplant, as well as the occurrence of cGVHD can accelerate cataract development. 34 Van Kempen-Harteveld et al 35 reported that shielding the eyes during TBI correlates with a decreased occurrence of cataract and an increased latency time, without increasing the risk of central nervous system relapses.…”