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Ocular Involvement in Patients With Posttransplant Lymphoproliferative Disorder
Andrew S. Cho, MD;
Gary N. Holland, MD;
Ben J. Glasgow, MD;
Sherwin J. Isenberg, MD;
Barbara L. George, MD;
Sue V. McDiarmid, MD
Arch Ophthalmol. 2001;119:183-189.
Objectives To describe ocular disease in 3 patients with posttransplant lymphoproliferative
disorder (PTLD) and to identify the frequency of such ocular involvement.
Methods Medical record reviews. Using Kaplan-Meier analysis, we calculated the
frequency of ocular involvement among pediatric patients with systemic PTLD
after liver transplantation.
Results Each patient had bilateral anterior chamber cells. Biopsy of an iris
nodule from a patient who had undergone cardiac transplantation confirmed
the diagnosis of PTLD, but no signs of systemic PTLD were found. The other
2 patients had systemic PTLD after liver transplantation; 1 presented with
iris nodules in both eyes and a subretinal mass in the left eye, while the
other had bilateral anterior chamber cells only. Ocular signs improved slowly
after reduction of immunosuppressive drug therapy. Ophthalmological examinations
were performed on 22 of 25 pediatric patients with PTLD after liver transplantation;
2 had ocular disease. Kaplan-Meier analysis indicated a 20% risk of ocular
involvement at 3 years after development of PTLD (95% confidence intervals,
0%-50%).
Conclusions Posttransplant lymphoproliferative disorder should be considered in
the differential diagnosis of uveitis after organ transplantation. Anterior
chamber cells and iris nodules are the most common ocular signs, but the posterior
segment can be involved. Ocular involvement can occur without evidence of
systemic disease and can be asymptomatic. Reduction of immunosuppressive drug
therapy is an appropriate treatment.
From the University of California, Los Angeles, Ocular Inflammatory
Disease Center, the Jules Stein Eye Institute, and the Department of Ophthalmology
(Drs Cho, Holland, Glasgow, and Isenberg); and the Departments of Pathology
(Dr Glasgow) and Pediatrics (Drs George and McDiarmid), University of California,
Los Angeles, School of Medicine.
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