Hematopoietic cell transplantation (HCT) is a highly effective treatment modality for several hematologic disorders, but it is often characterized by life-threatening complications that can arise during therapy.1,2 The majority of complications are attributable to graft-versus-host disease (GVHD), which is one of the leading causes of morbidity and mortality following HCT. Although not as common, non-GVHD ocular complications also have the potential to cause lifelong morbidity, reduce quality of life, and impair daily living activities.
In a review article published in Biology of Blood and Marrow Transplantation, Yoshihiro Inamoto, MD, of the division of hematopoietic stem cell transplantation at the National Cancer Center Hospital in Japan, and colleagues summarized the current literature on non-GVHD ocular complications and provided recommendations to help guide clinical practice.
Amer Beitinjaneh, MD, MS, of the division of hematology and oncology at the University of Miami in Florida, told Hematology Advisor, “Cataracts are one of the most frequent late [non-GVHD] ocular complications seen after HCT. They are more common and often require surgical intervention after total body irradiation-[based conditioning], [compared with] chemotherapy-based conditioning.”
Pathogenesis of Non-GVHD Ocular Complications
The most common non-GVHD ocular complications after HCT include cataracts, ocular infections, malignancy, ischemic microvascular retinopathy (IMR), glaucoma, central retinal vein occlusion (CRVO), and other retinal concerns such as detachment and hemorrhage. Researchers have identified several factors that may lead to these complications post-transplant, including conditioning regimen, bacteria or viruses, drug-related causes, and certain systemic diseases. However, the pathogenesis of IMR, CRVO, and some malignancies with ocular involvement have not been completely elucidated.
The most prevalent organisms leading to ocular infections post-HCT are gram-positive and gram-negative bacteria, Aspergillus and Candida fungi species, and several viruses, including cytomegalovirus (CMV), herpes simplex virus, varicella zoster virus, and adenovirus. CMV is the viral pathogen that most often infects the eyes, which can lead to retinal detachment and hemorrhage. In addition, recent studies have linked systemic conditions, such as hyperlipidemia, diabetes mellitus, and hypertension, with the development of CRVO.
“Prolonged steroid use, including inhaled steroids, is associated with an increased risk of cataracts in this patient population,” Dr Beitinjaneh said.
Treatment of Non-GVHD Ocular Complications
Due to variations in pathophysiology, specific treatment strategies for these ocular complications greatly differ. Although surgical intervention is usually required to treat cataracts, clinical assessment by an ophthalmologist is also necessary to confirm the diagnosis and determine timing for surgery. Ocular infections are often treated with intravenous antibiotics, antifungals, or systemic antivirals, depending on the particular infectious agent. Other therapeutic approaches for these complications involve numerous drug therapies including topical or systemic corticosteroids, intravitreal antivascular endothelial growth factor agents, intravitreal steroid injections, and others.