Determine the ocular complications in school-age children and adolescents surviving at least one year following allogeneic bone marrow transplantation.
Retrospective cohort study METHODS: In our institutional study, 162 (7-18 years old) patients met our inclusion criteria with a mean age of 13.4 years at bone marrow transplantation. Follow up ranged from 13 months to 12 years (mean 4 years, median 3.2 years). Patient charts were screened for cataract formation, dry eye, and other anterior and posterior segment disease.
Cataract formation was noted in 57 patients. Univariate analysis showed that fractionated total body irradiation, race, and use of cytarabine significantly increased the incidence of cataracts forming (P < 0.05). Multivariate analysis of significant variables showed that total body irradiation was a risk factor for cataract formation. Of the 57 (97 eyes) that developed cataracts after bone marrow transplantation, 4 (6 eyes) required cataract surgery. After surgery, all patients had visual acuities of 20/20-20/25. Of the 162 patients, 51 developed dry eyes. Univariate analysis showed that age at transplantation, steroid use, chronic graft-versus-host disease, fludarabine use, melphalan use, thiotepa use, and receiving no pre-transplant conditioning regimen prior to bone marrow transplant significantly increased the risk of dry eye syndrome (p < 0.05). In multivariate analysis, chronic graft-versus-host disease was a significant risk factor for dry eye syndrome.
Due to the high incidence of cataract formation and dry eye disease in this population, we propose screening exams by a pediatric or general ophthalmologist at least every year.

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