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Outcome of Pediatric Cataract Surgery in Patients Who Have Undergone Bone Marrow Transplantation

Bone marrow is the soft, fatty tissue inside your bones. The bone marrow produces blood cells. Stem cells are immature cells in the bone marrow that give rise to all of your different blood cells. A bone marrow transplant is a procedure to replace damaged or destroyed bone marrow with healthy bone marrow stem cells.

Bone marrow transplantation (BMT) with pre-treatment conditioning is an established treatment for childhood leukemia, myelodysplastic syndrome and other hereditary and metabolic hematologic disorders. While BMT has increased life-expectancy for children with hematologic disorders, this life-saving intervention has a number of sequelae including cataract formation.

In this study, the authors presented the outcome of cataract surgery in children who have had BMT. The authors conducted a retrospective chart study with 15 BMT patients (28 eyes) who underwent cataract extraction between 2002 and 2012. Outcome measures included change in best corrected visual acuity (BCVA) and complications. 7 (47%) patients had acute lymphoid leukemia, 3 (20%) had acute myeloid leukemia, 2 (13%) had myelodysplastic syndrome, 1 (7%) had Fanconi anemia, 1 (7%) had juvenile myelomonocytic leukemia, and 1 (7%) had adrenoleukodystrophy. Patients received BMT at a mean age of 3.9 ± 1.6 years old. 12 (80%) patients received total body irradiation (TBI) and 3 of these 12 received cranial irradiation in addition to TBI; one (7%) received only cranial irradiation. Total body irradiation included head and eye exposure. Mean age of cataract surgery was 9.1 ± 2.3 years old; mean follow-up was 55.9 ± 45.1 months. All cataracts were of posterior subcapsular subtype.

Mean BCVA improved from 0.7 ± 0.4 logMAR to 0.3 ± 0.5 logMAR (p < 0.001). 23/28 eyes (80%) had cataract extraction with intraocular lens placement; 5/28 (20%) of the eyes had cataract extraction with primary posterior capsulotomy and anterior vitrectomy (PC/AVx). 23/23 (100%) of the eyes without primary PC/AVx developed posterior capsular opacification (PCO) an average of 2.3 ± 6.9 months after surgery. No eyes with primary PC/AVx eyes developed PCO. 

In conclusion, children with history of BMT have a predisposition of developing posterior subcapsular cataracts and have a high rate of visually significant PCO if the posterior capsule is left intact at the time of cataract surgery. Besides, although a primary posterior capsulotomy with anterior vitrectomy is effective in reducing the rate of developing visual axis opacification, Nd:YAG laser is an effective treatment for these patients and the posterior capsule can be left intact without consequence if the patient can be cooperative for this procedure.


Article by Ariel Chen and Kimberly G. Yen, from USA.

Full access: http://mrw.so/3iccfT

Image by socialmediasl444, from Flickr-cc.

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