Phacoemulsification in patients after allogeneic bone marrow transplantation
Phacoemulsification in patients after allogeneic bone marrow transplantation
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DOI：
10.1016/s0161-6420(01)00675-3
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发表时间：
2001-09-01
期刊：
影响因子：
13.7
通讯作者：
Dana, MR
中科院分区：
文献类型：
--
作者：
Balaram, M;Dana, MR
客观的。研究同种异体骨髓移植 (allo-BUT) 受者超声乳化手术的结果。设计：回顾性、非比较性、介入性病例系列。方法。对连续 19 名在同种异体 BMT 后出现视力明显白内障并随后接受超声乳化手术的患者的 34 只眼睛进行回顾性研究。主要结果指标：最后一次随访时的最佳矫正视力以及术后并发症的发生情况。结果：BMT 后平均间隔 37 个月进行手术，术后平均随访 13 个月。 21 只眼睛 (62%) 由于涉及泪腺的移植物抗宿主病 (GVHD) 导致 Schirmer I 评分低于正常。其中，71%（15 只眼睛）还因结膜 GVHD 而出现明显的眼表上皮病变。在白内障手术前，经常使用润滑（95%）、泪点阻塞（76%）、局部类固醇（33%）和其他局部免疫抑制疗法（14%）来控制GVHD引起的眼表疾病。 12 名患者 (63%) 还接受了全身类固醇和免疫抑制剂治疗。患者只有在眼表疾病得到良好控制后才进行手术。术后早期并发症包括眼压升高（三只眼）、干眼症恶化（两只眼）和角膜变薄（一只眼）。 44% 的眼睛出现后囊混浊 (PCO)，需要进行激光囊切开术。在术前患有结膜 GVHD 的眼睛中，47% 的患者在术后停止免疫抑制治疗后出现复发。最后一次随访时，33 只眼睛 (97%) 的视力为 20/30 或更好。结论。超声乳化术是 BMT 后出现白内障的患者恢复视力的有效方法。然而，必须在手术前后识别并积极治疗共存的眼部疾病，以确保良好的视力结果。
Objective. To study the outcomes of phacoemulsification in allogeneic bone marrow transplant (allo-BUT) recipients.Design: Retrospective, noncomparative, interventional case series.Methods. Retrospective study of 34 eyes of 19 consecutive patients who had visually significant cataracts after allo-BMT and subsequently underwent phacoemulsification.Main Outcome Measures: Best-corrected vision at the last follow-up visit and development of postoperative complications.Results: Surgery was done at a mean interval of 37 months after BMT, and the mean postoperative follow-up was 13 months. Twenty-one eyes (62%) had subnormal Schirmer I scores as a result of graft-versus-host disease (GVHD) involving the lacrimal gland. Of these, 71% (15 eyes) additionally had significant ocular surface epitheliopathy because of conjunctival GVHD. Frequent lubrication (95%), punctal occlusion (76%), topical steroids (33%), and other topical immunosuppressive therapies (14%) were used to manage GVHD-induced ocular surface disease before cataract surgery. Twelve patients (63%) also received systemic steroids and immunosuppressives. Patients proceeded to surgery only after their ocular surface disease was well controlled. Early postoperative complications included intraocular pressure elevation (three eyes), worsening of dry eye syndrome (two eyes), and corneal thinning (one eye). Posterior capsular opacification (PCO) requiring laser capsulotomy occurred in 44% of eyes. In eyes with preoperative conjunctival GVHD, 47% had recurrence with cessation of immunosuppressive therapy after surgery. Visual acuity at last follow-up visit was 20/30 or better in 33 (97%) eyes.Conclusions. Phacoemulsification is an effective procedure in restoring vision in patients who have cataracts develop after BMT. However, coexisting ocular disease must be recognized and aggressively treated both before and after surgery to ensure good visual outcomes.