Progression Of Cataract In Patients Following Kidney Transplantation Under Immunosuppressive Therapy

Chronic kidney disease (CKD) is a significant public health problem with a high risk of developing age-dependent eye diseases.

A total of 160 patients (320 eyes) with end-stage non-diabetic chronic kidney disease who underwent kidney transplantation were observed. All patients received immunosuppressive therapy according to the following regimen: Tacrolimus 6 mg/day with blood concentration monitoring (normal range 13-10 ng/mL up to 3 months, 10-7 ng/mL from 3-6 months, 8-6 ng/mL from 6-12 months, 7-5 ng/mL after 12 months); Mycophenolate mofetil 1000 mg/day; Methylprednisolone 16 mg/day. Quantitative assessment of lens opacity based on LOCS III grading was conducted to investigate the effect of immunosuppressive therapy on the degree of lens opacification over time.

A pronounced trend of cataract progression, primarily affecting the nucleus and cortical masses, was observed in the eyes of patients after kidney transplantation. Consequently, surgical interventions for cataract removal and intraocular lens implantation were performed in the sample of patients at 2 and 3 years of follow-up due to significant opacity and decreased best-corrected visual acuity. A total of 22 cataract phacoemulsifications (6.88%) were performed post-kidney transplantation. Cases of weakness in the zonular-capsular apparatus of the lens, which could alter the traditional surgical approach, were not encountered. All surgeries resulted in favorable outcomes with significant improvement in visual function.

The findings suggest that immunosuppressive therapy, particularly Tacrolimus, administered to patient’s post-kidney transplantation affects the dynamics of cataract progression and requires additional intervention from ophthalmologists to perform cataract surgery. Presumably, the development and progression of lens opacity during prolonged Tacrolimus therapy may be attributed to its diabetogenic effect, leading to increased sorbitol levels in the blood, biological fluids, and tissues, including the lens, as demonstrated in experiments with laboratory animals.