Modern cataract surgery for radiation-induced cataracts in retinoblastoma. Issue 2 (24th June 2010)

• Record Type: Journal Article
• Authors: Osman, Ihab M; Abouzeid, Hana; Balmer, Aubin; Gaillard, Marie-Claire; Othenin-Girard, Philippe; Pica, Alessia; Moeckli, Raphaël; Schorderet, Daniel F; Munier, Francis L
• Is Part Of: British journal of ophthalmology. Volume 95:Issue 2(2011)
• Page Start: 227
• Page End: 230
• Publication Date: 2010-06-24
• Subjects: Retinoblastoma -- radiotherapy -- brachytherapy -- paediatric cataract surgery -- radio-induced cataract -- lens and zonules -- retina -- neoplasia -- treatment other -- child health (paediatrics); Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjo.2009.173401
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : Background: Surgery of radiation-induced cataracts in children with retinoblastoma (RB) is a challenge as early intervention is weighted against the need to delay surgery until complete tumour control is obtained. This study analyses the safety and functional results of such surgery. Methods: In a retrospective, non-comparative, consecutive case series, we reviewed medical records of RB patients ≤14 y of age who underwent either external beam radiotherapy or plaque treatment and were operated for radiation-induced cataract between 1985 and 2008. Results: In total, 21 eyes of 20 RB patients were included and 18 out of the 21 eyes had Reese-Ellsworth stage V or ABC classification group D/E RB. Median interval between last treatment for RB and cataract surgery was 21.5 months, range 3–164 months. Phacoaspiration was performed in 13 eyes (61%), extra-capsular cataract extraction in 8 (39%) and intraocular lens implantation in 19 eyes (90%). The majority of cases, 11/21 (52%), underwent posterior capsulorhexis or capsulotomy and 6/21 (28%) an anterior vitrectomy. Postoperative visual acuity was ≥20/200 in 13 eyes and <20/200 in 5 eyes. Intraocular tumour recurrence was noted in three eyes. Mean postoperative follow up was 90 months±69 months. Conclusions: Modern cataract surgery, including clear cornea approach, lens aspiration with posterior capsulotomy, anterior vitrectomy and IOL implantation is a safe procedure for radiation-induced cataract as long as RB is controlled. The visual prognosis is limited by initial tumour involvement of the macula and by corneal complications of radiotherapy. We recommend a minimal interval of 9 months between completion of treatment of retinoblastoma and cataract surgery.