de Melo Franco Rafael, Kron-Gray Michelle M, De la Parra-Colin Paola, He Yan, Musch David C, Mian Shahzad I, Niziol Leslie, Soong H Kaz
*Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI; †Department of Ophthalmology, Cornea and External Disease Division, Santa Casa de Misericórdia, São Paulo, Brazil; and ‡Beijing Ophthalmic and Visual Science Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, Beijing, China.
Cornea. 2015 May;34(5):506-11. doi: 10.1097/ICO.0000000000000395.
To study the outcomes of cataract surgery in patients with graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (HSCT).
Retrospective review of 72 eyes of 41 patients (age, 17-69 years at the time of surgery) with chronic GVHD after HSCT, who underwent cataract surgery between 2008 and 2012 at the Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan. Ophthalmic data collected included best-corrected visual acuity (BCVA), responses to Ocular Surface Disease Index (OSDI) questionnaire, dry eye severity, and postoperative complications.
BCVA improved from 20/49 to 20/25 (P < 0.0001) after surgery. Eight patients (20%) had pretransplantation total body irradiation and 39 patients (95%) received systemic corticosteroids for the treatment of GVHD. Postoperative complications included cystoid macular edema (4 eyes), corneal ulceration with perforation (2 eyes: 1 infected and 1 sterile), and band keratopathy (1 eye). After surgery, subjective OSDI responses and dry eye disease (DED) did not change significantly from before cataract surgery, although OSDI showed a trend toward worsening.
With careful monitoring and management of DED and concurrent ocular surface disease, cataract surgery generally has good visual outcomes in patients with GVHD. However, aggravation of the preexisting ocular surface disease is frequent, and despite meticulous postoperative maintenance therapy, vision-threatening complications may occur.
研究异基因造血干细胞移植（HSCT）后发生移植物抗宿主病（GVHD）的患者白内障手术的效果。
回顾性分析2008年至2012年期间在密歇根大学W.K.凯洛格眼科中心眼科与视觉科学部接受白内障手术的41例（手术时年龄17 - 69岁）HSCT后患有慢性GVHD患者的72只眼。收集的眼科数据包括最佳矫正视力（BCVA）、眼表疾病指数（OSDI）问卷的应答情况、干眼严重程度及术后并发症。
术后BCVA从20/49提高到20/25（P < 0.0001）。8例患者（20%）移植前接受过全身照射，39例患者（95%）接受全身皮质类固醇治疗GVHD。术后并发症包括黄斑囊样水肿（4只眼）角膜溃疡穿孔（2只眼：1只感染，1只无菌）及带状角膜病变（1只眼）。术后，主观OSDI应答及干眼疾病（DED）与白内障手术前相比无显著变化，尽管OSDI有恶化趋势。
通过对DED及并发眼表疾病进行仔细监测和管理，白内障手术在GVHD患者中通常具有良好的视力结果。然而，既往存在的眼表疾病经常加重，且尽管术后进行了精心的维持治疗，仍可能发生威胁视力的并发症。
