Abstract
Purpose: Bone marrow transplantation (BMT) and pre-treatment conditioning increases the risk of developing pediatric cataracts. We present the outcome of cataract surgery in children who have had BMT. Methods: We conducted a retrospective chart study with 15 BMT patients (28 eyes) who underwent cataract extraction between 2002 and 2012. Outcome measures include change in best corrected visual acuity (BCVA) and complications. Results: 7 (47%) patients had acute lymphoid leukemia, 3 (20%) had acute myeloid leukemia, 2 (13%) had myelodysplastic syndrome, 1 (7%) had Fanconi anemia, 1 (7%) had juvenile myelomonocytic leukemia, and 1 (7%) had adrenoleukodystrophy. Patients received BMT at a mean age of 3.9 ± 1.6 years. 12 (80%) patients received total body irradiation (TBI) and 3 of these 12 received cranial irradiation in addition to TBI; one (7%) received only cranial irradiation. Total body irradiation included head and eye exposure. Mean age of cataract surgery was 9.1 ± 2.3 years; mean follow-up was 55.9 ± 45.1 months. All cataracts were of posterior subcapsular subtype. Mean BCVA improved from 0.7 ± 0.4 logMAR to 0.3 ± 0.5 logMAR (p
Highlights
Bone marrow transplantation (BMT) with pre-treatment conditioning is an established treatment for childhood leukemia, myelodysplastic syndrome and other hereditary and metabolic hematologic disorders
Mean best corrected visual acuity (BCVA) improved from 0.7 ± 0.4 logMAR to 0.3 ± 0.5 logMAR (p < 0.001). 23/28 eyes (80%) had cataract extraction with intraocular lens placement; 5/28 (20%) of the eyes had cataract extraction with primary posterior capsulotomy and anterior vitrectomy (PC/AVx). 23/23 (100%) of the eyes without primary PC/AVx developed posterior capsular opacification (PCO) an average of 2.3 ± 6.9 months after surgery
Children with history of BMT have a predisposition of developing posterior subcapsular cataracts and have a high rate of visually significant PCO if the posterior capsule is left intact at the time of cataract surgery
Summary
Bone marrow transplantation (BMT) with pre-treatment conditioning is an established treatment for childhood leukemia, myelodysplastic syndrome and other hereditary and metabolic hematologic disorders. While BMT has increased life-expectancy for children with hematologic disorders, this life-saving intervention has a number of sequelae including cataract formation. Common conditioning pre-treatments for BMT include irradiation, corticosteroid treatment, and chemotherapy, each of which have been independently observed to be associated with increased cataract formation [1] [2] [3] [4] [5]. A number of studies have found that total body irradiation (TBI), compared to chemotherapy and corticosteroids, is likely the most significant factor for developing cataracts in patients who received BMT [6]-[11]. This study aims to characterize the cataracts that develop in pediatric bone marrow transplant patients and describe the complications and visual outcomes of cataract surgery in these patients
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