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

Abstract

Ischaemic retinopathy is a well characterised complication of bone marrow transplantation (BMT). Although the aetiology is unclear, it is most probably multifactorial, and may be related to treatment such as radiation and cyclosporin A. The clinical findings are reported of two patients who developed such a retinopathy and the ocular histology from one of these cases is presented. Two patients underwent BMT for acute lymphoblastic leukaemia, receiving campath-1G for prophylaxis against graft versus host disease, and showed fundal changes compatible with BMT retinopathy. The eyes from one patient were retrieved at post mortem and examined by both light and electron microscopy. The visual symptoms and fundal signs resolved spontaneously with no specific treatment in one patient. Light and electron microscopic examination of the eyes of the other patient was compatible with an ischaemic aetiology and showed evidence of retinal capillary endothelial loss. (i) Histopathology in one case of BMT retinopathy demonstrates a retinal endotheliopathy similar to that described in radiation retinopathy. (ii) BMT retinopathy may occur in the absence of cyclosporin A treatment. (iii) The retinopathy can recover spontaneously with no specific treatment.