This study describes the ocular complications associated with bone marrow transplant (BMT) and maintenance therapy in a preschool population.

Study design

This is a retrospective review of ocular complications in patients younger than age 7 years who underwent allogeneic BMT at St. Jude Children's Research Hospital between 1995 and 2010. The authors examined records from 91 children (mean age 3.2 years) who received an ophthalmic examination at baseline and at least 1 exam within 5 years after BMT.

Outcomes

Of the 91 children, 37 (41%) developed cataracts and 8 required cataract surgery. The cumulative incidence of cataract development was 54.2% at 10 years and 58.4% at 14 years. All patients who developed cataracts had total body irradiation (TBI), and 67% of those who received TBI developed cataract. There was no correlation between cataract formation and radiation dose.

Limitations

Young children may not be able to express concerns about their vision or draw attention to symptoms of dry eye disease, which were identified in 14.3% of the study population. Patients who developed cataracts were followed for much longer periods than those without cataracts (mean follow-up 10.3 years vs 4.0 years).

Clinical significance

Due to the patients’ young age at the time of BMT, their increased vulnerability to amblyopia and the high incidence of cataract, an ophthalmologist should follow up with these patients every year for life. There should be a low threshold for administering topical dry eye treatments in this patient population.