Visual outcome and cataract development after allogeneic stem-cell transplantation in children.

PURPOSE: To report visual functions and prevalence of cataract after haematopoetic stem-cell transplantation (SCT) during childhood and to determine the impact of different conditioning regimes and other possible risk factors.

METHODS: Assessment of visual acuity (VA), slit-lamp biomicroscopy of the lenses and examination of the ocular fundii were performed in 79 subjects 2-18 years (median 7 years) after SCT.

RESULTS: Best-corrected decimal VA > or = 0.5 was achieved in 152/158 eyes (96%). There was an increased risk of cataract after conditioning with single-dose total body irradiation (s-TBI) or fractionated TBI (f-TBI) compared to busulfan or other chemotherapy (P < 0.001) and an increased risk of developing cataract earlier if treated with s-TBI compared to f-TBI (P < 0.01). The TBI mode did not affect the time to first surgical intervention. Apart from s-TBI and f-TBI, age was found to be an independent risk factor. Cataract also developed in patients prepared with chemotherapy but no patient required surgery. Neither treatment with steroids for 6 months or longer nor history of chronic graft versus host disease (GVHD) influenced cataract development.

CONCLUSION: Conditioning with full dose f-TBI compared to s-TBI postpones but does not prevent cataract or cataract surgery while chemotherapy-based conditioning induces less severe cataracts, usually not requiring surgery. Corticosteroids or GVHD do not appear as risk factors.