Ocular complications after organ and bone marrow transplantation in children

Abstract

The author performed a retrospective review of 93 children younger than 18 years of age who underwent organ and bone marrow transplantation surgery at the University of Wisconsin between 1989 and 2004 to determine the rate and type of ocular complications. Seventy-four children who had pre- and post-transplantation eye examinations were included in the analysis. The mean age at the time of transplantation was 7.6 years (range, 4 months to 18 years). The organ transplants comprised mainly of renal (n = 26), liver transplants (n = 25), and bone or stem cell transplants (n = 18). The mean duration of follow up was 2.3 years (range, 1 month to 14 years). The 1-year post-transplantation complication rate was 16.0% (95% confidence interval 6.8% to 24.4%). Overall, 15 patients (20.2%) developed ocular complications, of which 11 occurred in the first year. Among these 15 patients, 14 were prescribed systemic prednisone, cyclosporine, or a combination of both as part of their post-transplantation regimen. Major adverse events included posterior subcapsular cataract (five patients; nine eyes), graft-vs-host disease (three patients), cytomegalovirus (CMV) retinitis (two patients; four eyes), persistent strabismus (two patients), lymphoproliferative disorder (one patient), and transient visual loss (one patient; two eyes). Four patients underwent surgery for ocular complications, including cataract surgery (two patients), tarsorrhaphy for corneal ulceration (one patient), and iris biopsy (one patient) to diagnose post-transplantation lymphoproliferative disorder. Twenty-five eyes (83.3%) had a final visual acuity of 20/40 or better. The vision of one patient with CMV retinitis deteriorated to no light perception in one eye and 20/250 in the other eye. The authors conclude that organ and bone marrow transplantation is associated with a substantial risk of ocular complications, although most patients can maintain a final visual acuity of 20/40 or better.—Michael D. Wagoner