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Abstract
To study the outcomes of phacoemulsification in allogeneic bone marrow transplant
(allo-BMT) recipients.
Retrospective, noncomparative, interventional case series.
Retrospective study of 34 eyes of 19 consecutive patients who had visually significant
cataracts after allo-BMT and subsequently underwent phacoemulsification.
Best-corrected vision at the last follow-up visit and development of postoperative
complications.
Surgery was done at a mean interval of 37 months after BMT, and the mean postoperative
follow-up was 13 months. Twenty-one eyes (62%) had subnormal Schirmer I scores as
a result of graft-versus-host disease (GVHD) involving the lacrimal gland. Of these,
71% (15 eyes) additionally had significant ocular surface epitheliopathy because of
conjunctival GVHD. Frequent lubrication (95%), punctal occlusion (76%), topical steroids
(33%), and other topical immunosuppressive therapies (14%) were used to manage GVHD-induced
ocular surface disease before cataract surgery. Twelve patients (63%) also received
systemic steroids and immunosuppressives. Patients proceeded to surgery only after
their ocular surface disease was well controlled. Early postoperative complications
included intraocular pressure elevation (three eyes), worsening of dry eye syndrome
(two eyes), and corneal thinning (one eye). Posterior capsular opacification (PCO)
requiring laser capsulotomy occurred in 44% of eyes. In eyes with preoperative conjunctival
GVHD, 47% had recurrence with cessation of immunosuppressive therapy after surgery.
Visual acuity at last follow-up visit was 20/30 or better in 33 (97%) eyes.
Phacoemulsification is an effective procedure in restoring vision in patients who
have cataracts develop after BMT. However, coexisting ocular disease must be recognized
and aggressively treated both before and after surgery to ensure good visual outcomes.