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Posterior segment complications and the risk factors after allogeneic hematopoietic stem cell transplantation

Abstract

Purpose

To study the posterior segment complications (PSC) and the risk factors in patients after allogeneic hematopoietic stem cell transplantation (HSCT).

Methods

This cross-sectional, case-control study enroled 143 patients who received allogeneic HSCT. Comprehensive ocular examinations were performed to evaluate PSC and ocular Graft-versus-Host Disease (oGVHD). PSC was diagnosed based on the characteristic fundus findings and auxiliary examinations. Visual-evoked potential was examined in patients with unexplained visual loss and suspected visual pathway pathology (VPP). Ocular surface disease index, corneal fluorescein staining, conjunctival injection and Schirmer’s test were scored to diagnose oGVHD.

Results

PSC was detected in 36 (25.2%) patients, while 107 (74.8%) patients were not. Among them, 102 (71.3%) patients were diagnosed with oGVHD. The most common PSC included cytomegalovirus retinitis (13/143, 9.1%) and VPP (7/143, 4.9%). Central nervous system relapse of leukaemia was detected in four out of seven cases of VPP. Patients with PSC had worse visual acuity, lower prevalence and milder severity of oGVHD, and more donors from unrelated and human leucocyte antigen (HLA)-mismatch (all P < 0.05). PSC was associated with transplant from unrelated (OR = 6.494, 95% CI: 1.635–25.794, P = 0.008) and HLA-mismatched (OR = 7.193, 95% CI: 2.829–18.291, P < 0.001) donor but not with the occurrence of systemic GVHD or oGVHD.

Conclusions

PSC in post-HSCT patients was more common than previously noted, deserving the concern of ophthalmologists, especially in patients with unrelated or HLA-mismatched donors.

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Data availability

Data are available upon reasonable request from the authors.

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Funding

This study is supported by grants from the National Natural Science Foundation of China (82070922, 82101133), and the High-level Hospital Construction Project of Guangdong Province (303020101).

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Contributions

All authors contributed to the study’s conception and design. Boyu Yang, Shaowen Wu, Shanshan Yu, Xiaoling Liang, and Qifa Liu performed the material preparation, data collection and analysis. Boyu Yang, Lingyi Liang and Fen Huang wrote the first draft of the manuscript, and all authors commented on previous versions. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Fen Huang or Lingyi Liang.

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Yang, B., Wu, S., Yu, S. et al. Posterior segment complications and the risk factors after allogeneic hematopoietic stem cell transplantation. Eye (2022). https://doi.org/10.1038/s41433-022-02250-9

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