Ocular involvement in children with beta-thalassemia major

Abstract

Aim: Thalassemia is a severe genetic blood disorder, and several organs, including eyes, can be affected. The mechanism of ocular abnormalities in thalassemia is multifactorial; one of them is regular blood transfusion, which can cause iron overload. Ocular abnormalities can also occur because of the side effects of iron chelators. This study evaluated ocular involvement in children with Beta-thalassemia major and its association with serum ferritin levels. Methods: A cross-sectional study was undertaken at the Thalassemia daycare center in a tertiary referral hospital in Medan. All patients’ hemoglobin was measured before transfusion, and serum ferritin levels were measured at six-month intervals. A Pediatric Ophthalmologist carried out the ophthalmological assessment, which included a detailed history of visual problems and visual acuity testing. Fisher’s Exact test and Spearman test were used for 
statistical calculation. Results: Thirty-seven beta-thalassemia major children ranging from three to 18 years old. Visual acuity, anterior segment, fundus, and retina were evaluated. Ophthalmologic examinations showed that ocular involvement increased with age. Visual acuity was reduced in 16.2% of the subjects. Papilledema was the most common ocular finding among the subjects (13.5%), followed by cataracts (8.1%) and optic atrophy (8.1%). A significant correlation between blood transfusion volume and serum ferritin levels was found. Conclusion: Ocular involvement was found in more than half of the subjects in this study. However, regular ophthalmologic 
evaluations by serum ferritin examination were required to detect early alterations in their visual system for a better quality of life.