Outcomes and complications of cataract surgery in patients with chronic ocular graft-versus-host-disease-a multicenter, retrospective analysis

Abstract

Purpose: To evaluate the outcome of phacoemulsification in patients with chronic ocular Graft-versus-host disease (oGVHD) after allogeneic hematopoietic stem cell transplantation (aHSCT).

Methods: Retrospective, observational multicenter study from 1507 oGVHD patients. From the patient files, data were collected including best-corrected visual acuity (BCVA), intraocular pressure (IOP), Schirmer's test I, tear film break-up time (TFBUT), corneal fluorescein staining score, postoperative complications, and pre- and post-operative topical therapy.

Results: Seventy-three patients underwent cataract surgery in 104 eyes. In n = 84 eyes, the oGVHD NIH grade was documented; 12% (n = 12) of analyzed eyes were staged oGVHD NIH grade 1, 31% (n = 32) NIH 2 and 39% (n = 41) NIH 3. The mean BCVA improved in 82% of the eyes (n = 86 eyes). BCVA significantly increased from 0.7 ± 0.5 to 0.4 ± 0.4 LogMAR after surgery independent from oGVHD severity. The mean IOP decreased from 14 ± 4 to 13 ± 4 mmHg after surgery. Visual acuity was moderately correlated to the pre-operative degree of corneal staining (Pearson p = 0.26, p = 0.002, Cohen's effect size f = 0.29). The visual acuity decreased by 0.078 LogMar units (95% CI = 0.027-0.141) with each increase of corneal staining by one grade (p = 0.05). After surgery, corneal epitheliopathy increased significantly in 42% (n = 44) of the eyes. Postoperative complications included corneal perforation (n = 6, 6%), cystoid macular edema (n = 4, 4%), and endophthalmitis (n = 1, 1%).

Conclusion: Phacoemulsification in patients with chronic oGVHD significantly improves visual acuity, but is associated with an increased risk of complications in particular corneal epitheliopathy and corneal perforations.

Keywords: Cataract; Complication; Graft-versus-host-disease; Phacoemulsification.

Fig. 1

Outcome after cataract surgery related to severity of oGVHD (NIH grade 1–3). a NIH grade of n = 84 oGVHD eyes (in 20 eyes NIH grades were not documented). Twelve percent of analyzed eyes were graded NIH 1, 31% NIH 2, and 39% were NIH 3. b Visual acuity after cataract surgery improved in all groups independent from the NIH grade. c In NIH 1 and 2 staining increased after surgery to an NIH 3 level. NIH 3 group had a significantly higher corneal fluorescein staining at baseline compared to NIH 1 and 2

Fig. 2

Corneal epitheliopathy after cataract surgery in n = 76 eyes calculated from the alteration in corneal staining (Oxford) before and after surgery. In 54% of the eyes, staining was impaired after surgery; in 23% of the eyes, corneal staining did not change. In 16%, corneal staining improved. In NIH 1 group, 63% of the eyes impaired, in NIH 2 65%, and in NIH 3 45%

Fig. 3

Ophthalmological parameters prior and after cataract surgery in n = 27 ASED-treated and n = 15 control eyes (no ASED) with NIH grade 3 only. a Visual acuity improved in both groups. b Schirmer’s increased in control eyes, but not in ASED-treated eyes. c Intraocular pressure decreased in both groups. d Mean corneal staining increased in ASED-treated eyes after surgery. e Changes in corneal epitheliopathy after surgery in ASED and control eyes. No statistical differences between both treatment groups were observed in the number of eyes exacerbating after surgery. (ASED = autologous serum eye drops)