Dhal Udit, Raju Shine, Singh Arun D, Mehta Atul C
Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA.
Respiratory Institute, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA.
J Thorac Dis. 2018 Nov;10(11):6285-6297. doi: 10.21037/jtd.2018.09.156.
Ophthalmic complications in the lung transplant population are a little-known entity. It includes a spectrum of diseases ranging from infections such as cytomegalovirus (CMV) retinitis, herpetic keratitis, to non-infectious complications such as posterior subcapsular cataracts (PSCs), cyclosporine retinopathy, and post-transplant lymphoproliferative disorder (PTLD). These diseases can be attributed to high levels of immunosuppression, advanced age, and drug-specific side effects. Underlying comorbidities such as diabetes mellitus may also play a role in the pathogenesis. Patients can present with varied symptoms such as blurry vision, floaters or eye pain. Prompt diagnosis often requires a high index of suspicion. With increasing numbers of transplants being performed worldwide, it is imperative for the pulmonologist and transplant physician to recognize these often subtle symptoms. Any visual symptom should trigger an ophthalmological evaluation in order to manage these complications; some of which pose the risk of systemic dissemination and significant morbidity. The following article provides an in-depth review of the common presenting symptoms, treatments and recent advances related to common ophthalmic complications following lung transplantation. While this article focuses on the lung transplant sub-population, the authors would like to point out that some of these complications are shared by other solid-organ transplants as well, by virtue of their shared immunosuppressive therapies.
肺移植人群中的眼科并发症是一个鲜为人知的情况。它包括一系列疾病,从诸如巨细胞病毒(CMV)视网膜炎、疱疹性角膜炎等感染性疾病,到诸如后囊下白内障(PSC)、环孢素视网膜病变和移植后淋巴细胞增生性疾病(PTLD)等非感染性并发症。这些疾病可归因于高水平的免疫抑制、高龄和药物特异性副作用。诸如糖尿病等潜在合并症在发病机制中也可能起作用。患者可能出现各种症状,如视力模糊、飞蚊症或眼痛。及时诊断通常需要高度的怀疑指数。随着全球范围内进行的移植手术数量不断增加,肺科医生和移植医生认识到这些往往很细微的症状至关重要。任何视觉症状都应引发眼科评估,以便处理这些并发症;其中一些并发症存在全身播散和严重发病的风险。以下文章对肺移植后常见眼科并发症的常见表现症状、治疗方法和最新进展进行了深入综述。虽然本文重点关注肺移植亚人群,但作者想指出,由于免疫抑制治疗方法相同,其中一些并发症在其他实体器官移植中也存在。