Atypical retinal microvasculopathy after bone marrow transplantation

Objective: Typical early ischaemic retinal microvascular changes with cotto n wool spots after allogeneic bone marrow transplantation (BMT) are well re cognised. In this study an atypical non-ischaemic late retinopathy is descr ibed. Methods: Sequential cases of late retinal microvasculopathy following allog eneic BMT were reviewed. Demographic features and clinical and angiographic data were collected. Results: Of 399 patients undergoing allogeneic BMT between 1992 and 1999, e ight eyes of four patients developed atypical retinopathy. All patients wer e male and the age range was 27-50 (mean 37.5) years. The indications for B MT were acute lymphoblastic leukaemia (two patients), chronic myeloid leuka emia (one patient) and chronic lymphocytic leukaemia (one patient). Two pat ients had conditioning regimens including irradiation. All had cyclosporine and methotrexate as graft-versus-host disease prophylaxis. All but one had cyclophosphamide and busulphan as conditioning treatment. One had interfer on. No patients had sustained hypertension or diabetes mellitus. Atypical r etinopathy was identified 13-62 (mean 50) months after BMT and clinical fea tures consisted of microaneurysms (MA; 4/4), hard exudates (1/4) and macula r oedema (1/4). No patient had cotton wool spots. The median acuity was 6/5 . Angiographic features were MA (4/4), late leak (2/4) and peripheral (1/4) or central (1/4) ischaemia. One patient underwent focal photocoagulation f or macular oedema. Conclusion: Retinal microvascular incompetence (without cotton wool spots) with good vision may occur in a small number of patients as a late complica tion of allogeneic BMT.