Ocular involvement in patients with posttransplant lymphoproliferative disorder

Objectives: To describe ocular disease in 3 patients with posttransplant ly mphoproliferative disorder (PTLD) and to identify the frequency of such ocu lar involvement. Methods: Medical record reviews. Using Kaplan-Meier analysis, we calculated the frequency of ocular involvement among pediatric patients with systemic PTLD after liver transplantation. Results: Each patient had bilateral anterior chamber cells. Biopsy of an ir is nodule from a patient who had undergone cardiac transplantation confirme d the diagnosis of PTLD, but no signs of systemic PTLD were found. The othe r 2 patients had systemic PTLD after liver transplantation; 1 presented wit h iris nodules in both eyes and a subretinal mass in the left eye, while th e other had bilateral anterior chamber cells only. Ocular signs improved sl owly after reduction of immunosuppressive drug therapy. Ophthalmological ex aminations were performed on 22 of 25 pediatric patients with PTLD after li ver transplantation; 2 had ocular disease. Kaplan-Meier analysis indicated a 20% risk of ocular involvement at 3 years after development of PTLD (95% confidence intervals, 0%-50%). Conclusions: Posttransplant lymphoproliferative disorder should be consider ed in the differential diagnosis of uveitis after organ transplantation. An terior chamber cells and iris nodules are the most common ocular signs, but the posterior segment can be involved. Ocular involvement can occur withou t evidence of systemic disease and can be asymptomatic. Reduction of immuno suppressive drug therapy is an appropriate treatment.