RETINAL MICROVASCULAR CHANGES FOLLOWING BONE-MARROW TRANSPLANTATION -THE ROLE OF CYCLOSPORINE

Three patients complained of deteriorating vision 16, 20 and 29 weeks following bone marrow transplantation (BMT) while receiving cyclospori ne (CsA). Opthalmic examination revealed a marked microvascular retino pathy with multiple cotton-wool spots, macular stars and retinal oedem a. These appearances could not be accounted for by the mild to moderat e hypertension in two cases, the third patient being normotensive. Two of the patients had received total body irradiation (TBI) and cycloph osphamide (CY) as conditioning therapy for BMT as well as previous cra nial irradiation for acute lymphoblastic leukaemia; one case with chro nic myeloid leukaemia was conditioned with busulphan and CY. Withdrawa l of CsA in two patients and reduction of dose in the third led to com plete resolution of retinopathy and restoration of visual function. Pr evious reports have documented ischaemic fundus lesion in BMT recipien ts treated with CsA and TBI. Our findings suggest that CsA in associat ion with busulphan can produce a similar retinopathy.