Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada.
Cornea. 2022 May 1;41(5):587-592. doi: 10.1097/ICO.0000000000002779.
The aim of this study was to evaluate the outcomes of cataract surgery in patients with chronic ocular graft-versus-host disease (GVHD).
A retrospective review was performed on 77 eyes of 42 patients with chronic ocular GVHD that underwent cataract surgery between January 2014 and February 2020 in a tertiary institution.
Posterior subcapsular cataract was seen in 53 (68.8%) of 77 eyes, with a mean preoperative corrected distance visual acuity (CDVA) of 0.61 ± 0.49 logarithm of the minimum angle of resolution (logMAR). Postoperatively, with a mean follow-up of 21 months, CDVA improved to 0.17 ± 0.22 logMAR at the latest visit (P < 0.0001). With latest available refraction, 42 (57.5%) of 73 eyes were within 0.5 diopters of target refraction, and 59 eyes (80.8%) were within 1.0 diopter. Postoperative complications included superficial punctate keratopathy within 1 month postoperatively (19 eyes, 24.7%), posterior capsular opacification requiring yttrium-aluminum-garnet (YAG) laser capsulotomy (36 eyes, 46.8%), corneal epithelial defect (7 eyes, 9.1%), filamentary keratopathy (5 eyes, 6.5%), cystoid macular edema (3 eyes, 3.9%), and infectious crystalline keratopathy (1 eye, 1.3%). Lower preoperative National Institutes of Health ocular GVHD severity scores were associated with a better postoperative CDVA (grade 1, 0.13 ± 0.16 logMAR; grade 2, 0.16 ± 0.23 logMAR; and grade 3, 0.36 ± 0.21 logMAR; P = 0.004).
Cataract surgery improves visual acuity long term in most patients with chronic ocular GVHD. Close postoperative monitoring is important to detect ocular surface inflammation secondary to chronic ocular GVHD, particularly in severe ocular GVHD.
本研究旨在评估慢性眼移植物抗宿主病（GVHD）患者白内障手术的结果。
回顾性分析 2014 年 1 月至 2020 年 2 月在一家三级医疗机构接受白内障手术的 42 例慢性眼 GVHD 患者的 77 只眼。
77 只眼中 53 只（68.8%）出现后发性白内障，术前最佳矫正远视力（CDVA）平均为 0.61±0.49 最小分辨角对数（logMAR）。术后平均随访 21 个月，末次随访时 CDVA 提高至 0.17±0.22 logMAR（P<0.0001）。根据最新的屈光度数，73 只眼中有 42 只（57.5%）在目标屈光度数的 0.5 屈光度以内，59 只眼（80.8%）在 1.0 屈光度以内。术后并发症包括术后 1 个月内出现浅层点状角膜病变（19 只眼，24.7%）、需要钇铝石榴石（YAG）激光后囊切开术的后发性白内障（36 只眼，46.8%）、角膜上皮缺损（7 只眼，9.1%）、丝状角膜病变（5 只眼，6.5%）、囊样黄斑水肿（3 只眼，3.9%）和感染性结晶状角膜病变（1 只眼，1.3%）。术前 NIH 眼移植物抗宿主病严重程度评分较低与术后 CDVA 较好相关（1 级为 0.13±0.16 logMAR；2 级为 0.16±0.23 logMAR；3 级为 0.36±0.21 logMAR；P=0.004）。
白内障手术可长期提高大多数慢性眼 GVHD 患者的视力。术后密切监测对发现慢性眼 GVHD 引起的眼表炎症很重要，尤其是在严重眼 GVHD 中。
