ABSTRACT
PURPOSE: To determine the risk of, and risk factors for, developing cataracts after bone marrow transplantation. METHODS AND MATERIALS: Four hundred and ninety-two adults who underwent bone marrow transplantation in Seattle were followed for 2 to 18 (median, 6) years. Before transplantation, patients received a preparative regimen of chemotherapy plus total body irradiation (TBI) (n = 407) or chemotherapy alone, without TBI (n = 85). TBI was administered in a single dose of 10 Gy (n = 74) or in fractionated doses totaling 12-15.75 Gy (n = 333). The risk of cataracts was determined for groups of patients with respect to the type of preparative regimen received and other pretransplant and posttransplant variables. RESULTS: One hundred and fifty-nine patients (32%) developed cataracts between 0.5 to 11 (median, 2.3) years after transplantation. The probability of cataracts at 11 years after transplantation was 85%, 50%, 34%, and 19% for patients receiving 10 Gy of single-dose TBI, > 12 Gy fractionated TBI, 12 Gy fractionated TBI, and no TBI, respectively (p < 0.0001). Among those developing cataracts, the severity was greater in patients after single-dose TBI (59% probability of surgical extraction) than after > 12 Gy fractionated TBI, 12 Gy fractionated TBI, or no TBI (33%, 22% and 23%, respectively). Patients given corticosteroids after transplant had a higher probability of cataracts (45%) than those without steroids (38%) (p < 0.0001). In a proportional hazards regression model, the variables that were correlated with an increased probability of cataracts were single-dose TBI (relative risk (RR) = 2.46) and steroid therapy (RR = 2.34), while a decreased probability of cataracts was correlated with a nonTBI preparative regimen (RR = 0.41). The yearly hazard of developing cataracts in recipients of single-dose TBI was highest during the third year after transplantation, while in recipients of fractionated TBI, the hazard was distributed among years one through seven. The probability of cataracts in all groups reached a plateau at 7 years after transplantation, after which the development of cataracts was extremely unlikely. CONCLUSION: TBI is the major risk factor for developing cataracts after BMT. Single-dose TBI results in the highest risk of cataracts. However, the risk of cataracts in recipients of fractionated-TBI is significantly higher than in patients who receive no TBI. In addition to TBI, steroid therapy is an independent risk factor for cataracts after BMT.
Subject(s)
Bone Marrow Transplantation/adverse effects , Cataract/etiology , Steroids/adverse effects , Whole-Body Irradiation/adverse effects , Adolescent , Adult , Cataract Extraction , Female , Follow-Up Studies , Graft vs Host Disease/complications , Humans , Male , Middle Aged , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Radiotherapy Dosage , Risk Factors , Time FactorsABSTRACT
This report describes the case of a homosexual man with non-Hodgkin's lymphoma, whose primary complaint involved his ocular system.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Ophthalmoplegia/etiology , Adult , Humans , MaleABSTRACT
Graft-v-host disease is the major complication of bone marrow transplantation for the leukemias and aplastic anemia. In the clinical evaluation of eye problems of patients with acute graft-v-host disease, findings reveal a disease process of keratoconjunctivitis that appears to represent a specific pathologic eye syndrome in which the conjunctivae and occasionally the cornea represent an immunologic target of graft-v-host disease. Additional studies of eye problems of chronic graft-v-host disease reveal the persistent nature of keratitis sicca and the morbid sequelae of the immunoincompetent patient.
Subject(s)
Graft vs Host Disease/complications , Graft vs Host Reaction , Keratoconjunctivitis/etiology , Acute Disease , Adolescent , Adult , Bone Marrow Transplantation , Child , Child, Preschool , Chronic Disease , Cornea/pathology , Graft vs Host Disease/etiology , Humans , Keratoconjunctivitis/pathology , Middle Aged , Xerophthalmia/etiologyABSTRACT
Patients who have received marrow transplants and total body irradiation with different forms of chemotherapy should be routinely watched by an ophthalmology service because of the high incidence of dry eye syndrome, viral keratitis, and trophic disturbances of the cornea. Herpes simplex keratitis must be strongly suspected in bizarre corneal findings associated with geographic epithelial denudement accompanying acute GVHD. Acute GVH ocular syndrome warrants clinical recognition when, in the course of severe GVHD, the eyes reveal keratoconjunctivitis with associated herpes simplex infections of the cornea, later to show chronic problems of severe drying conjunctival and corneal scarring compatible with Stevens-Johnson syndrome.
Subject(s)
Anemia, Aplastic/therapy , Eye Diseases/etiology , Leukemia, Lymphoid/therapy , Leukemia, Myeloid, Acute/therapy , Adolescent , Adult , Antineoplastic Agents/adverse effects , Bone Marrow Transplantation , Child , Child, Preschool , Corneal Ulcer/etiology , Graft vs Host Reaction , Humans , Immunosuppression Therapy/adverse effects , Middle Aged , Radiotherapy/adverse effects , Viremia/etiology , Xerophthalmia/etiologyABSTRACT
In the repair of large defects of the lower lid near the medial canthus, reconstruction with flaps and grafts is met with the problem of aligning variable skin thicknesses. This method of repair provides an alternative technique in which replacement of both thick and thin skin deficienies are met.
Subject(s)
Eyelids/surgery , Skin Transplantation , Surgical Flaps/methods , Cheek , Facial Neoplasms/surgery , Humans , Male , Middle Aged , Nose , Transplantation, AutologousABSTRACT
A patient with chronic conjunctivitis was found to have a parasitic nematode infection of the conjunctiva. The parasite was found within the cul-de-sac of the conjunctiva, entirely motile. The treatment of the conjunctivitis was simple removal of the organism, and periodic follow up.
