Ocular Complications after Organ and Bone Marrow Transplantation in Children

Department of Ophthalmology and Visual Sciences, University of Wisconsin–Madison, Madison, Wisconsin, United States
Journal of American Association for Pediatric Ophthalmology and Strabismus (Impact Factor: 1). 10/2005; 9(5):426-32. DOI: 10.1016/j.jaapos.2005.06.002
Source: PubMed


Organ and bone marrow transplantation commonly are performed in children. Ocular complications usually are described as secondary to post-transplantation medications. The complication rate is unknown.
A retrospective chart review was performed of 93 children who were younger than 18 years of age and had transplantation surgery from 1989 to 2004. The rate and type of ocular complications, including those requiring ocular surgery, were analyzed. Medications and visual loss associated with adverse effects also were studied.
Of the 93 patients, 74 patients met the entry criteria. Sixty-one patients had at least 1 year of follow-up, and the longest follow-up duration was 14 years. The 1-year post-transplantation complication rate was 16.0% (95% confidence interval 6.8-24.4%). Adverse effects included cytomegalovirus (CMV) retinitis, cataract, graft-versus-host disease, lymphoproliferative disorder, persistent strabismus, and transient visual loss. Four patients underwent eye surgery, including lensectomy for cataract, tarsorrhaphy for corneal ulcer, and iris biopsy. They had surgery 0.9 to 4.7 years after transplantation. Most patients were taking prednisone and cyclosporine when their complication was diagnosed. One patient's visual acuity deteriorated to no light perception in one eye and 20/250 in the other eye secondary to CMV retinitis. Most patients had a final visual acuity > or =20/40.
Transplantation surgery in children produces a significant risk of ocular impairment. The 1-year complication rate was 16.0%. Eye surgery may be required within the first few years after transplantation. Although most patients maintained a final visual acuity of 20/40 or better, one patient became bilaterally legally blind.

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    • "Cytomegalovirus (CMV) retinitis is a severe sight-threatening disease which predominantly affects patients with AIDS [1-3]. CMV retinitis may also occur in patients who are lymphopenic secondary to immunosuppressive therapy after bone marrow or solid organ transplantation [4,5]. Unless effective treatment is promptly initiated, the disease may lead to progressive visual loss and blindness [6,7]. "
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