Bone Marrow Transplants: Kids Need Annual Eye Exams

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An investigation of ocular complications following allogeneic bone marrow transplantation (BMT) in young children found this popula­tion to be at increased risk for cataract development, a risk that increases over time.¹ These children are also at risk for dry eye disease.

“These patients need lifetime yearly eye exams for cataract development,” said Mary Ellen Hoehn, MD, at the University of Tennessee Health Science Center in Memphis. What’s more, phy­sicians should have a low threshold for detecting and treating dry eye, she said.

The retrospective review included 91 consecutive patients aged 6 years or younger (mean age, 3.2 years) at the time of treatment. Average follow-up was 5.8 years (range, 2 months to 14 years). The most common indications for BMT were acute lymphoblastic leu­kemia (26 patients) and acute myeloge­nous leukemia (18 patients).

Complications. Cataract occurred in 72 eyes of 37 patients (41%) over a 14-year period, with the incidence rising over time, from 54.2% at 10 years to 58.4% at 14 years.

Nearly one-fifth of these patients (n = 8) required bilateral cataract surgery. Following intraocular lens im­plantation, visual acuities ranged from 20/20 to 20/40, with 1 “uncooperative tester” achieving 20/80.

Doctors diagnosed dry eye disease in 13 children (14.3%), none of whom had dry eye prior to BMT. At 14 years, the prevalence was greater than 40%. While the finding did not reach sta­tistical significance, Dr. Hoehn said it might have if the children had been more articulate and more cooperative with Schirmer testing and slit-lamp examinations. Other complications were rare, she added.

Radiotherapy as a risk factor. Every patient in the study who developed cataracts had received total body irra­diation (TBI), a form of radiotherapy sometimes used prior to BMT. But not all patients receiving TBI developed cataracts. And dose did not matter: There was no significant difference in TBI dose between those who developed cataract and those who did not.

A new finding. The chemotherapy drug cytarabine has not previously been linked to cataract development. But this study reports a 78.6% inci­dence for cataract formation over 14 years in those patients who took the drug. In contrast, thiotepa and busulfan were associated with a decreased risk of cataract development.

Clinical implications. The study does, however, suggest that “patients need fairly close follow-up during the first year after BMT,” Dr. Hoehn said, with at least yearly appointments for life. She added, “They should have urgent dilated eye exams if there is a systemic fungal infection, as these patients may not be able to complain of visual changes. And any suspicion of dry eye should be treated with a trial of lubricating drops.”

Despite the complications, Dr. Hoehn said, “I was pleasantly surprised that very few patients lost vision from com­plications of bone marrow transplanta­tion.”

—Miriam Karmel

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1 Hoehn ME et al. J AAPOS. Published online Jan. 5, 2018.

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Relevant financial disclosures—Dr. Hoehn: None.

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