INFECTIOUS OCULAR COMPLICATIONS IN ORTHOTOPIC LIVER-TRANSPLANT PATIENTS

We report the frequency and type of infectious ocular complications fo llowing orthotopic liver transplantation (OLT) and review diagnostic a nd therapeutic strategies. During the period September 1988 through No vember 1994, 684 patients underwent OLT at Mount Sinai Hospital (New Y ork). Nine orthotopic liver transplant patients (1.3%) developed ocula r infections: Candida albicans endophthalmitis (2), Aspergillus fumiga tus endophthalmitis (1), cytomegalovirus retinitis (4), herpes simplex virus keratitis (1), and varicella-zoster virus panophthalmitis (1). The mean time from OLT to ocular symptoms was 42 days for patients wit h fungal infections and 128 days for patients with viral infections. B lunted vision was the commonest symptom (five of nine cases). The mean duration of follow-up was 2 years (range, 33 days to 5 years). Perman ent loss of vision occurred in three patients, five had improvement in visual acuity, and one died of disseminated aspergillosis 33 days aft er OLT. Infectious ocular complications following OLT may occur as iso lated events or with disseminated disease. Fungal infections occur ear lier (mean, 42 days after OLT) than viral infections (mean, 4 months a fter OLT). The clinical presentation may be atypical; aggressive vitre oretinal procedures and serial examinations may be required to establi sh the diagnosis. Cytomegalovirus retinitis in orthotopic liver transp lant patients may not require life-long maintenance therapy with antiv iral agents.