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Cataract Formation after Bone Marrow Transplantation

Andre Tichelli, MD; Alois Gratwohl, MD; Thomas Egger, MD; Jakob Roth, MD, PhD; Alexandra Prunte, MD; Catherine Nissen, MD; and Bruno Speck, MD
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From the University Hospitals, Basel, Switzerland. Requests for Reprints: Andre Tichelli, MD, Hamatologische Abteilung, Departement Innere Medizin, Petersgraben 4, CH-4031 Basel, Switzerland. Acknowledgments: The authors thank Anita Nadolny and Ann Barbara Maerki for help in preparing the manuscript. Grant Support: In part by the Swiss National Science Foundation (grant 32-31316.91).

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;119(12):1175-1180. doi:10.7326/0003-4819-119-12-199312150-00004
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Objective: To evaluate the incidence, time course, and factors associated with cataract formation in bone marrow transplant recipients.

Design: Prospective cohort study.

Setting: University Hospitals, Basel, Switzerland.

Patients: 197 patients treated with allogeneic or autologous bone marrow grafts at least 180 days before the start of the study.

Intervention: Three regimens for bone marrow transplant were used: 74 patients received single-dose, total-body irradiation (TBI), 90 patients received fractionated TBI, and 33 received chemotherapy alone.

Results: Three and one half years after single-dose TBI, 51 of the 74 patients (69%) were alive and cataracts had developed in all of these 51 patients. Cataracts developed in 18 of the 90 (20%) patients treated with fractionated TBI, with an 83% (95% CI, 63% to 100%) risk for lens opacification at 6 years\f. Cataracts developed in only 1 of the 33 (3%) patients treated with chemotherapy alone. Incidence of cataracts is higher and lens opacification occurs earlier after single-dose TBI than after fractionated TBI (P < 0.01). With Cox regression analysis, the use of irradiation (relative risk, 21.0), the mode of irradiation (relative risk, 7.4), and the use of steroid treatment (relative risk, 2.9) for more than 3 months after bone marrow transplantation increased the risk for cataract formation. In contrast, age, sex, and chronic graft-versus-host disease did not influence the rate of cataract development. The probability of requiring cataract surgery after 6 years was 85% (CI, 75% to 95%) for the patients treated with single-dose TBI and 20% (CI, 0% to 49%) for those prepared with fractionated irradiation.

Conclusions: Patients treated with TBI, regardless of fractionation, are likely to have cataracts within 10 years, and some will need surgical repair. Long-term steroid treatment accelerates cataract formation. Preventive measures, such as lens shielding during TBI, should be considered.


Grahic Jump Location
Figure 1.
The probability of cataract development in 197 patients who were given preparatory single-dose, total-body irradiation, fractionated irradiation, or chemotherapy alone (no irradiation) and then bone marrow transplantation.

TBI = total body irradiation; fTBI = fractionated total body irradiation; STBI = single-dose, total body irradiation.

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Figure 2.
The probability of requiring cataract surgery in 197 patients who were given preparatory single-dose or fractionated total-body irradiation and then bone marrow transplantation.
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