Ocular complications are common in patients undergoing allogeneic hematopoietic stem cell transplantation for hematologic disorders and malignancies, according to the results of a retrospective observational study.
Dr. Khalid F. Tabbara and colleagues at the King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, examined results for 620 patients with hematologic or lymphoid malignancies or nonneoplastic hematologic disorders who underwent allogeneic hematopoietic stem cell transplantation (HSCT) in 1997-2007. The stem cell source was allogeneic donor bone marrow in 459, peripheral blood in 151 patients, and cord blood in 10 patients. All patients had a baseline ophthalmologic examination and subsequently a complete ophthalmologic examination after ocular complications developed; 1-year follow-up was available for 447 patients.
Of the 620 patients, 80 (44 women; mean age, 29 years) developed major ocular complications. In all, 34 of the 80 patients developed chronic graft vs. host disease (GVHD), a major complication after HSCT.
GVHD typically involves ocular complications, most commonly keratoconjunctivitis sicca (KCS, or dry-eye syndrome), which in this study occurred in 29 of 34 patients. Dry-eye syndrome without evidence of systemic GVHD developed in 30 patients, corneal ulcers in 15 patients, steroid-induced cataract in 8 patients, and glaucoma in 6 patients.
Other complications included cytomegalovirus infection (four patients), allergic conjunctivitis (four patients), uveitis (four patients), and fungal endophthalmitis (one patient), according to the investigators.
KCS in patients with GVHD tended to be more serious, with 8 patients rated grade 1 (mild), 12 rated grade 2, and 9 rated grade 3. In contrast, KCS in those patients without GVHD was rated grade 1 in 22 patients, grade 2 in 5, and grade 3 in 3 (Ophthalmology 2009;116:1624-9).
“Major ocular complications may have been overlooked if the patients were so ill that they did not request ophthalmologic consultation,” the researchers stated. They reported no financial disclosures. The study was supported in part by a fund from the Eye Center and the Eye Foundation for Research in Ophthalmology in Riyadh.