BONE-MARROW TRANSPLANTATION AND CATARACT DEVELOPMENT

Objectives: To evaluate risk factors for the development of posterior subcapsular cataract following bone marrow transplantation (BMT) and t he results of patients undergoing cataract extraction. Designs: Retros pective case-control study. Setting: Tertiary referral center. Patient s: Three hundred sixty-six patients (59% male, 41% female) undergoing BMT at one institution who survived for at least 1 month and underwent full ophthalmologic examination. Risk factors were then compared betw een patients who developed posterior subcapsular cataract and those wh o did not. Intervention: Cataract surgery in six eyes of four patients . Main Outcome Measure: Formation of posterior subcapsular cataract. D ata were obtained on all patients for type of BMT, pretransplantation regimen, underlying malignancy, demographic background, complications of BMT, and medications. Results: Forty (10.9%) of 366 patients develo ped posterior subcapsular cataract. By univariate analysis, cataract f ormation was associated with total body irradiation, chronic graft-vs- host disease, the use of allogeneic bone marrow, and the total dose an d duration of corticosteroid therapy. Multivariate analysis revealed t hat the total dose and duration of corticosteroid therapy were the mos t important risk factors, while total body irradiation was not a stati stically significant risk factor. Cataract surgery was performed in si x eyes of four patients, all of whom developed visual acuities of 20/4 0 or better. Conclusion: Posterior subcapsular cataract following BMT is uncommon and rarely requires surgery. Total dose and duration of co rticosteroid therapy are the most important risk factors for developme nt of cataract, but total body irradiation is not a statistically sign ificant risk factor.