Optic disc and retinal microvasculopathy after high-dose chemotherapy and autologous hematopoietic progenitor cell support

Abstract

Summary:The purpose of this study was to prospectively evaluate the retinal and optic nerve changes in patients undergoing high-dose chemotherapy (HDC) followed by autologous hematopoietic progenitor cell support (AHPCS). One hundred and forty patients undergoing HDC and AHPCS underwent extensive pre-and post-transplant ophthalmologic evaluations for development of retinal microvascular complications. One hundred and ten patients received high-dose cyclophosphamide, cisplatin and BCNU; thirty received identical doses of cyclophosphamide and cisplatin, but received paclitaxel instead of BCNU. Thirty-four patients (24%) had retinal findings of either cotton wool spots (CWS) (n = 20) or retinal hemorrhages (n = 18) during follow-up, which ranged from 1 to 12 months. Ten (7%) of these patients, all of whom received BCNU, showed ocular toxicity characterized by CWS 1 to 4 months post transplant (n = 10); optic disc edema (n = 3); and variable vision loss associated with the onset of BCNU-induced pulmonary toxicity. Retinal and optic disc microvascular complications may occur after high-dose chemotherapy followed by AHPCS. The association of ischemic retinal lesions and/or optic disc edema with BCNU-induced pulmonary toxicity and the lack of ocular toxicity in patients that did not receive BCNU may suggest that BCNU is the etiologic agent.

Atypical retinal microvasculopathy after bone marrow transplantation

“…Three of them were first found to have these changes 5 years after BMT, their fundi having been recorded as normal in the intervening period. This again contrasts strongly with previous accounts where the occlusive changes were seen mostly within the first 6 months, 1,3,5–8,11 the latest being at 2 years 2,4,10 …”

“…Retinal microvascular changes after bone marrow transplantation (BMT) have been well described 1–11 . Studies to date have focused on identifying the factors in conditioning therapy and graft‐versus ‐ host disease (GVHD) prophylaxis that are most associated with its development.…”

Clinical Evaluation of Gemcitabine in Dogs with Spontaneously Occurring Malignancies

“…23 In people, posterior segment toxicity with cotton wool spots, retinal hemorrhage, or optic disc edema has been reported in patients treated with IV, intra-arterial, or combination chemotherapy with 1,3 bis(2-chloroethyl)-1-nitrosourea (BCNU). 24,25 One of the authors has observed similar lesions in a dog treated with BCNU and radiation (C.G. Couto, personal communication).…”

Reversible branch retinal artery occlusion following intravenous cisplatin chemotherapy for cervical carcinoma

“…This was reversed on discontinuing CDDP. Previously reported ophthalmic complications associated with CDDP chemotherapy include macular retinal pigment abnormality, retinal ischaemia with neovascularisation, retinal microvascular complications, subclinical retinal dysfunction, cone dysfunction, optic neuropathy and cortical blindness [5][6][7][8][9][10][11]. To the best of our knowledge this is the first case report of reversible branch retinal artery occlusion from CDDP therapy.…”