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Cataracts and cGVHD‐associated keratoconjunctivitis sicca are common ocular late effects. Other eye exposure‐based complications for which formal ophthalmologic evaluations might be indicated include ischemic microvascular retinopathy (TBI, CNI, carmustine, busulfan), central retinal vein occlusion (metabolic syndrome or hypercoagulability) and ocular infections (late CMV disease, HSV, VZV, bacterial, fungal and toxoplasmosis). Thus, history should ask about impaired vision, dry or gritty eyes, diplopia, halos and history of opportunistic infections.

Twenty‐five percent to 50% of pediatric survivors will develop lens cataracts; mostly, these are not visually significant. Relevant exposures are TBI or prior cranial irradiation followed, less frequently, by busulfan and glucocorticoids. Using NIH consensus criteria, 30% of children with cGVHD developed dry eyes (9% with keratoconjunctivitis sicca) [31]; prior cranial/eye radiation can increase this risk [40]. Ophthalmologic examinations are advised at 1‐year post‐HCT, then yearly if abnormal or symptomatic. The NIH cGVHD eye score is helpful for symptom screening and treatment response [41].