Ocular Complications in Children Within 1 Year After Hematopoietic Stem Cell Transplantation

Importance: It is essential to have insights into the risk of ocular involvement after hematopoietic stem cell transplantation (HSCT) in the pediatric population because young and severely ill children are unaware of their ocular problems. Objective: To study the development of ocular complications in children within 1 year after HSCT. Design and Setting: This prospective study includes all consecutive patients who had undergone an HSCT at the Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands, in 2009 and 2010. Participants: Forty-nine consecutive patients underwent systematic ophthalmologic evaluations before HSCT, before leaving the HSCT unit after HSCT, and 3, 6, and 12 months after HSCT. Additional examinations were performed during systemic viral reactivations. Main Outcome Measure: Development of ocular complications, including uveitis, hemorrhagic complications, optic disc edema, and dry eye syndrome. Results: Thirteen patients (27%) developed an ocular complication after HSCT. These complications included DES (n=7 [14%]), (sub) retinal hemorrhage (n=6 [12%]), optic disc edema (n=3 [6%]), chorioretinal lesions (n=2 [4%]), vitritis (n=1 [2%]), and increased intraocular pressure (n=1 [2%]). Median time to the development of dry eye syndrome was 5 months after HSCT, whereas all other ocular complications were detected within the first 3months after HSCT. In most cases, the symptoms were mild and self-limiting. Children with malignant disease had a higher risk of the development of ocular complications compared with children with nonmalignant disease. Conclusions and Relevance: Ocular complications in pediatric HSCT patients are common, although mostly mild. The risk of viral uveitis development during systemic viral reactivations is low; however, the potential risk of vision-threatening complications in this population cannot be ruled out.