Abstract
PurposeTo evaluate the outcome of phacoemulsification in patients with chronic ocular Graft-versus-host disease (oGVHD) after allogeneic hematopoietic stem cell transplantation (aHSCT).MethodsRetrospective, observational multicenter study from 1507 oGVHD patients. From the patient files, data were collected including best-corrected visual acuity (BCVA), intraocular pressure (IOP), Schirmer’s test I, tear film break-up time (TFBUT), corneal fluorescein staining score, postoperative complications, and pre- and post-operative topical therapy.ResultsSeventy-three patients underwent cataract surgery in 104 eyes. In n = 84 eyes, the oGVHD NIH grade was documented; 12% (n = 12) of analyzed eyes were staged oGVHD NIH grade 1, 31% (n = 32) NIH 2 and 39% (n = 41) NIH 3. The mean BCVA improved in 82% of the eyes (n = 86 eyes). BCVA significantly increased from 0.7 ± 0.5 to 0.4 ± 0.4 LogMAR after surgery independent from oGVHD severity. The mean IOP decreased from 14 ± 4 to 13 ± 4 mmHg after surgery. Visual acuity was moderately correlated to the pre-operative degree of corneal staining (Pearson p = 0.26, p = 0.002, Cohen’s effect size f = 0.29). The visual acuity decreased by 0.078 LogMar units (95% CI = 0.027–0.141) with each increase of corneal staining by one grade (p = 0.05). After surgery, corneal epitheliopathy increased significantly in 42% (n = 44) of the eyes. Postoperative complications included corneal perforation (n = 6, 6%), cystoid macular edema (n = 4, 4%), and endophthalmitis (n = 1, 1%).ConclusionPhacoemulsification in patients with chronic oGVHD significantly improves visual acuity, but is associated with an increased risk of complications in particular corneal epitheliopathy and corneal perforations.
Highlights
Chronic graft-versus-host-disease (GVHD) is a major cause of morbidity in patients after allogeneic hematopoietic stem cell transplantation as treatment for several hematological disorders such as acute lymphoblastic or myeloid leukemia
The aim of this study was to comparatively analyze data from 7 centers regarding the outcome after cataract surgery including complication rates in a larger number of patients, with a special focus on patients with severe oGvHD and application of autologous serum eye drops
The mean corneal staining significantly increased after surgery from 2.1 to 2.5 (Table 1)
Summary
Chronic graft-versus-host-disease (GVHD) is a major cause of morbidity in patients after allogeneic hematopoietic stem cell transplantation (aHSCT) as treatment for several hematological disorders such as acute lymphoblastic or myeloid leukemia. Acute or chronic ocular GvHD (oGVHD) is described in up to 60% of the patients, mainly affecting the ocular surface and adnexa [1–4]. Resulting in disturbed tear production [5], loss of meibomian glands [6–8], conjunctival scarring [9], corneal epithelial defects and perforation [10], corneal and conjunctival ulceration [11, 12], inflammation as well as consecutive ocular discomfort, pain and blurred vision, oGVHD leads to a significant reduction in the vision-related quality of life in these patients [13, 14]. As increasing numbers of patients are receiving aHSCT and transplantation techniques and conditioning strategies have improved, patients’ survival rates increase [15]. The number of oGVHD patients increases with a consecutive increase of longterm complications. Due to significant visual impairment related to cataracts, many patients subsequently have to undergo phacoemulsification
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