Pigmentary irregularities and optic disc edema after heart transplantation

C. C. Klaver, C. B. Hoyng and P. T. de Jong
Department of Ophthalmology, University Hospital Rotterdam, Dijkzigt, The Netherlands.

OBJECTIVES: To determine the prevalence of chorioretinal lesions and optic disc edema after heart transplantation and to study potential associations. DESIGN AND PATIENTS: One hundred one patients who had undergone heart transplantation at one institution and 19 patients prior to heart transplantation underwent ophthalmological examination, including fundus photography. The prevalence of fundus lesions was then compared between the two groups. MAIN OUTCOME MEASURE: With a standardized protocol, the presence of optic disc edema, chorioretinal hyperpigmentation and depigmentation, retinal hemorrhages, cotton-wool lesions, and arteriovenous nicking was graded on color transparencies. RESULTS: The prevalence of optic disc edema and hypopigmentations was significantly higher among the transplant recipients than among the patients prior to heart transplantation (31% vs 5%, P = .01, and 55% vs 11%, P < .001, respectively). Hyperpigmentation was only present in patients after transplantation (15% vs 0%, P = .06). Heart transplant recipients showed an increased risk of hyperpigmentations after 2.5 years. Acute rejection episodes were not associated with posterior pole lesions. CONCLUSION: Common posterior pole lesions after heart transplantation are optic disc edema and pigmentary changes. Although visual acuity does not seem severely impaired, further longitudinal study is necessary to evaluate the long-term significance of these lesions.