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

  1. Kristina Teär Fahnehjelm1,2,
  2. Alba-Lucia Törnquist3,
  3. Monica Olsson2,
  4. Jacek Winiarski4

Article first published online: 28 AUG 2007

DOI: 10.1111/j.1600-0420.2007.00991.x

Issue

Acta Ophthalmologica Scandinavica

Acta Ophthalmologica Scandinavica

Volume 85, Issue 7, pages 724–733, November 2007

Additional Information

How to Cite

Fahnehjelm, K. T., Törnquist, A.-L., Olsson, M. and Winiarski, J. (2007), Visual outcome and cataract development after allogeneic stem-cell transplantation in children. Acta Ophthalmologica Scandinavica, 85: 724–733. doi: 10.1111/j.1600-0420.2007.00991.x

Author Information

  1. 1

    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

  2. 2

    Department of Paediatric Ophthalmology and Strabismus, St Erik's Eye Hospital, Karolinska University Hospital, Huddinge, Stockholm, Sweden

  3. 3

    Department of Clinical Neuroscience, Unit of Optometry, St Erik's Eye Hospital, Stockholm, Sweden

  4. 4

    Department of Clinical Science and Technology, Karolinska Institutet and Department of Paediatrics, Karolinska University Hospital, Huddinge, Stockholm, Sweden

*Kristina Teär Fahnehjelm Department of Paediatric Ophthalmology and Strabismus St Erik's Eye Hospital Karolinska University Hospital Huddinge, B 54 S-141 86 Stockholm Sweden Tel: + 46 8585 81 550 Fax: + 46 8556 204 89 Email: kristina.fahnehjelm@ki.se

Publication History

  1. Issue published online: 18 OCT 2007
  2. Article first published online: 28 AUG 2007
  3. Received on February 6th, 2007. Accepted on May 30th, 2007.

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Keywords:

  • cataract;
  • graft versus host disease;
  • stem-cell transplantation;
  • steroids;
  • total body irradiation

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.

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