Ischaemic retinopathy occurring in patients receiving bone marrow allografts and campath-1G: a clinicopathological study.

Webster, Andrew R.; Anderson, Jane; Richards, Erica M.; Moore, A.

doi:10.1136/bjo.79.7.687

Cited by 24 publications

(19 citation statements)

References 15 publications

(1 reference statement)

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“…22 Ischemic retinopathy has been reported in patients conditioned with busulfan and cyclophosphamide without irradiation, 23 or in patients receiving Campath-1G for GVHD prophylaxis. 24 In most cases, retinal lesions resolve with withdrawal or reduction of immunosuppressive therapy, and resolution has even been described in a case associated with complete blindness. 25 Although ischemic retinopathy is still an enigma, these data suggest that the development of ischemic eye lesions is a multifactorial process leading to capillary damage of the eye fundus.…”

Section: Late Ocular Effects Ocular Complications Of the Posterior Sementioning

confidence: 99%

Nonmalignant late effects after allogeneic stem cell transplantation

Socié

Salooja²,

Cohen³

et al. 2003

Blood

369

208

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Section: Late Ocular Effects Ocular Complications Of the Posterior Sementioning

confidence: 99%

Nonmalignant late effects after allogeneic stem cell transplantation

Socié

Salooja²,

Cohen³

et al. 2003

Blood

369

208

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“…Although the aetiology is unclear, it is most probably multifactorial, and may be related to treatments such as radiation and cyclosporin. Webster et al 79 reported two patients who developed such a retinopathy and the ocular histology from one of these Ophthalmic manifestations of acute leukaemias T Sharma et al cases showed evidence of retinal capillary endothelial loss. The retinal endotheliopathy in this case was similar to that described in radiation retinopathy.…”

Section: Bone Marrow Transplant (Bmt)/gvhdmentioning

confidence: 99%

Ophthalmic manifestations of acute leukaemias: the ophthalmologist's role

Sharma

Grewal

Gupta

et al. 2004

Eye

206

166

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With evolving diagnostic and therapeutic advances, the survival of patients with acute leukaemia has considerably improved. This has led to an increase in the variability of ocular presentations in the form of side effects of the treatment and the ways leukaemic relapses are being first identified as an ocular presentation. Leukaemia may involve many ocular tissues either by direct infiltration, haemorrhage, ischaemia, or toxicity due to various chemotherapeutic agents. Ocular involvement may also be seen in graft-versushost reaction in patients undergoing allogeneic bone marrow transplantation, or simply as increased susceptibility to infections as a result of immunosuppression that these patients undergo. This can range from simple bacterial conjunctivitis to an endophthalmitis. Leukaemia can present as pathology in the adnexae, conjunctiva, sclera, cornea, anterior chamber, iris, lens, vitreous, retina, choroid, and optic nerve. Recognition of the varied ocular presentations is also important in assessing the course and prognosis of leukaemia. We have presented a systematic approach taking each part of the eye in turn and outlining how leukaemia has been shown to affect it.

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“…There are reported cases of relatively severe ischemic retinopathy after transplantation, some of that mimic a Purtscher retinopathy. 3 However, in general, bone marrow transplant retinopathy is typically mild and, to my knowledge, does not lead to phlebitis or arteritis like that seen in this case. Another thought is that this relentless occlusive vasculitis could be related to a severe graftversus-host reaction, but again the reported cases are not nearly as grave as the one presented here.…”

Section: Dr C Stephen Foster (Boston Massachusetts)mentioning

confidence: 48%

Diagnostic and Therapeutic Challenges

Tauqir¹,

Shulman²,

Bittencourt³

et al. 2013

Retina

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A 35-year-old Vietnamese physician presented to the clinic in December 2010 with reduced vision in both the eyes for 4 months. His medical history is significant for a myelodysplastic syndrome, refractory anemia with excess blasts-2, which transformed into acute myeloid leukemia, for which he received 3 cycles of azacitidine and 1 cycle of FLAG chemotherapy (fludarabine, cytarabine, and granulocyte colony-stimulating factor regimen) before eventually undergoing a reduced intensity-matched unrelated donor stem cell transplant in June 2010. Before his transplant, the patient was found to be positive for cytomegalovirus (CMV) and herpes simplex virus in the serum; the donor was also positive for CMV. After transplantation, he remained on cyclosporine (75/50 mg 2 times a day) for immunosuppression. His peritransplant course was complicated by Aspergillus pneumonia in April 2010, systemic CMV activation in July 2010 for which he was started on oral valganciclovir, and line-related (Hickman) Klebsiella sepsis in September 2010.The patient began to experience a painless reduced vision in the left eye starting in late August 2010. On evaluation, his visual acuity in the left eye was 20/160. Retinal examination of the left eye revealed increased attenuation of the vessels with flecken pigmentary changes, as well as intraretinal hemorrhages. Fluorescein angiogram showed attenuation of the arteries and veins in the left eye with capillary hyperfluorescence with no significant leakage noted in the late phase (Figure 1, August 2010). As he was positive for CMV in the serum, CMV vasculitis was suspected, and he was started on intravenous ganciclovir. Anterior chamber tap was negative for CMV, herpes simplex virus, and varicella zoster virus.Two weeks later, in September 2010, he was admitted for Klebsiella sepsis. Immediately following recovery, the visual acuity in the left eye worsened to counting fingers; the visual acuity in the right eye was 20/32, although an inferior field defect was detected. These changes were attributed to a central retinal artery occlusion in the left eye and branch retinal artery occlusion in the right eye (presumed to have happened when he was admitted to the intensive care unit for sepsis). He was evaluated for possible infectious, hypercoagulable and embolic conditions to ascertain the possible cause of the vaso-occlusive pathology.Chest computerized tomography and blood and urine cultures were negative for signs of infection. Magnetic resonance angiography showed 60% stenosis of the left external carotid and 32% stenosis of the right external carotid; however, ultrasound doppler of the carotids did not reveal any pathology. Serial electrocardiograms and holter monitoring were normal. Transthoracic echocardiogram showed no evidence of a patent foramen ovale. Hypercoagulable workup showed positive anticardiolipin antibodies and lupus anticoagulant. C-reactive protein and erythrocyte sedimentation rate were within normal limits with low protein S and normal protein C, along with other normal serol...

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Ischaemic retinopathy occurring in patients receiving bone marrow allografts and campath-1G: a clinicopathological study.

Abstract: Aims/Background-Ischaemic retinopathy is a well characterised complication of bone marrow transplantation (BMT)

Cited by 24 publications

References 15 publications

Nonmalignant late effects after allogeneic stem cell transplantation

Nonmalignant late effects after allogeneic stem cell transplantation

Ophthalmic manifestations of acute leukaemias: the ophthalmologist's role

Diagnostic and Therapeutic Challenges

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