Outcomes of phacoemulsification in patients with chronic ocular graft-versus-host disease

Abstract

Purpose

To evaluate the outcomes of phacoemulsification in patients with ocular graft-versus-host disease (GVHD).

Methods

The occurrence of cataract, cataract surgery and its outcomes were analyzed in the medical records of 229 patients (458 eyes) with ocular GVHD. Outcome measures included pre- and postoperative corrected distance visual acuity (CDVA) and the rate of postoperative complications.

Results

From 458 eyes evaluated 58 were pseudophakic, from the 400 phakic eyes 238 (59%) presented with cataracts and 62 (26%) underwent cataract surgery. Analysis of postoperative complications and visual outcomes at one month was performed in 51 eyes in which detailed surgical and immediate postoperative records were available. Preoperatively, the mean CDVA was 0.67±0.57 LogMAR (Snellen 20/93) and improved postoperatively to 0.17±0.18 (Snellen 20/29) at one month (P<0.0001), and to 0.13±0.14 (Snellen 20/26) by the final follow-up visit (P<0.0001). Postoperative complications included: corneal epithelial defects (8%), filamentary keratitis (6%), worsening of corneal epitheliopathy (16%), posterior capsular opacification (18%), and cystoid macular edema (4%). A corrected distance visual acuity of 20/30 or better was achieved in 87% of the eyes; suboptimal CDVA improvement was accounted by severe ocular surface disease, pre-existing advanced glaucoma, and prior macular surgery.

Conclusions

Phacoemulsification in patients with chronic ocular GVHD is a safe and efficacious procedure resulting in significant visual improvement. Overall, postoperative adverse events responded well to timely management.