A case of radiation cataract found 29 years after radiation exposure

Background. Ionizing radiation (IR) can affect the brain and the visual organ even at low doses, while provoking cognitive, emotional, behavioral, and visual disorders. We proposed to consider the brain and the visual organ as potential targets for the influence of IR with the definition of cerebro-ophthalmic relationships as the «eye-brain axis». Objective. The present work is a narrative review of current experimental, epidemiological and clinical data on radiation cerebro-ophthalmic effects in children, individuals exposed in utero, astronauts and interventional radiologists. Materials and methods. The review was performed according to PRISMA guidelines by searching the abstract and scientometric databases PubMed/MEDLINE, Scopus, Web of Science, Embase, PsycINFO, Google Scholar, published from 1998 to 2021, as well as the results of manual search of peer-reviewed publications. Results. Epidemiological data on the effects of low doses of IR on neurodevelopment are quite contradictory, while data on clinical, neuropsychological and neurophysiological on cognitive and cerebral disorders, especially in the left, dominant hemisphere of the brain, are nore consistent. Cataracts (congenital – after in utero irradiation) and retinal angiopathy are more common in prenatally-exposed people and children. Astronauts, who carry out longterm space missions outside the protection of the Earth’s magnetosphere, will be exposed to galactic cosmic radiation (heavy ions, protons), which leads to cerebro-ophthalmic disorders, primarily cognitive and behavioral disorders and cataracts. Interventional radiologists are a special risk group for cerebro-ophthalmic pathology – cognitive deficits, mainly due to dysfunction of the dominant and more radiosensitive left hemisphere of the brain, and cataracts, as well as early atherosclerosis and accelerated aging. Conclusions. Results of current studies indicate the high radiosensitivity of the brain and eye in different contingents of irradiated persons. Further research is needed to clarify the nature of cerebro-ophthalmic disorders in different exposure scenarios, to determine the molecular biological mechanisms of these disorders, reliable dosimetric support and taking into account the influence of non-radiation risk factors. Key words: ionizing radiation, brain, eye, cerebro-ophthalmic effects, radiation emergencies, prenatal irradiation, space flights, interventional radiology.

Section: Radiation Cerebro Ophthalmic Effects In Children and In Utero Irradiated Peopleunclassified

“…In the group exposed in utero (as well as in the comparison group), there was no typical clinical picture of radiation cataract described in persons exposed to adulthood [92] and in much higher doses [93], but congenital lens changes were poly morphic [88 ].…”

Section: Radiation Cerebro Ophthalmic Effects In Children and In Utero Irradiated Peoplementioning

confidence: 99%

Brain and Eye as Potential Targets for Ionizing Radiation Impact: Part Ii – Radiation Cerebro-Ophtalmic Effects in Children, Persons Exposed in Utero, Astronauts and Interventional Radiologists

Loganovsky¹,

Fedirko²,

Marazziti³

et al. 2021

Brain and Eye as Potential Targets for Ionizing Radiation Impact. Part Iv – Fetal Radiation-Induced Binocular Vision Disorders: A Pilot Study. Immunohistochemical Changes of Non-Irradiated Eyeball Muscles Affected by Strabismus. Evidence of a Possible Mechanism of the Strabismus Development in Persons Exposed to Fetal Radiation

Fedirko

Pilmane

Babenko

et al. 2022

Strabismus is a significant cause of a decrease in the functional capabilities of the organ of vision, additionally, it leads to the deteriorating quality of life. Orbital factors and nervous system changes may play an important role in strabismus pathogenesis. There are few reports on binocular vision disorders in radiation-exposed persons. Functions of the external eyeball muscles might be disturbed based on the changed coordination process of subcortical nerve structures and due to altered metabolism. A carefully conducted research is necessary to clarify the possible pathogenesis of binocular vision disorders in radiation-exposed persons. Objective: to assess the peculiarities of the development of strabismus and binocular vision disorders in people who were exposed to ionizing radiation in utero; to investigate the changes in distribution and appearance of myosin, dystrophin, and collagen IV between non-irradiated persons with normal binocular vision and patients with strabismus. Materials and methods. 583 persons, irradiated in utero because of the Chornobyl disaster were examined (at the time of examination average age was 11.3 ± 0.1 years). The control group – 808 people – Kyiv residents. Overall, 15 non-irradiated eyeball muscle samples were examined. 10 were from strabismus patients and 5 were controls. To evaluate morphological structure haematoxylin and eosin staining were used. For the detection of myosin, dystrophin, and collagen IV biotin-avidin (IMH) immunohistochemistry method was performed. Semi-quantitative grading method was used for the evaluation of immunoreactive structure appearance and local distribution. Results. An increased frequency of divergent strabismus (p = 0.04190) and heterophoria (p = 0.002603) was found in the group exposed to prenatal (fetal) radiation because of the Chornobyl disaster compared to the control group. The relative risk of heterophoria was 5.08 (1.42 – 18.13). A decrease in dystrophin, myosin, and collagen IV positive structures was observed in non-irradiated strabismus-affected eyeball muscles compared to the control group. Conclusions. Detected changes indicate an increased probability in the development of strabismus in persons who had been exposed to fetal radiation. Non-irradiated strabismus-affected eyeball muscles are characterized by diminished myosin, dystrophin, and collagen IV immunohistochemical structures. Additionally, determined qualitative morphological changes in skeletal striated muscle fibers lead to the changed structural organization, indicating possible muscular dystrophy. Thereby, the presence of dystrophic processes in the eyeball muscles may play a significant role in the morphopatogenesis of strabismus. Further morphological studies are necessary to clarify the development of binocular vision disorder and the methods of their correction. These studies would be especially important to populations that were exposed to radiation. Key words: irradiated in utero, ionizing radiation, strabismus, eyeball muscles, immunohistochemical studies, pathogenesis.

Brain and Eye as Potential Targets for Ionizing Radiation Impact. Part v – Organic and Functional Changes Correlation on the Example of Certain Diseases

Fedirko,

Babenko,

Kuts

et al. 2023

The question about correlation between organic and functional changes in persons, exposed to radiation is still insufficiently studied. Dynamics of morbidity for different forms and classes of non-tumour diseases periodisation, proposed by epidemiologists, suggests the identification of three main periods: «early» (the first 6 post-Chornobyl accident years); «distant» (12–21 years) and «late» (22–30 years). However, the correspondence this periodisation to the results of epidemiological data, without taking into account the clinical features of the diseases, may contribute to the impression, that in the first period after a radiation disaster functional disorders (or autonomic regulation disorders, etc.) prevail in all cases. Meanwhile, the data from ophthalmological and neurological studies, which we aim to demonstrate in this paper, rather indicate the presence of a significant morphological basis for the development of functional disorders in early period after a radiation disaster. The objective of this work is analyse modern experimental, epidemiological and clinical data on the correlation between organic and functional changes, characteristic of radiation cerebro-ophthalmological effects – radiation cataracts, age-related macular degeneration, cerebral small vessel disease, and neurocognitive deficits. Materials and methods. The criteria for inclusion in the analytical review were peer-reviewed publications in PubMed/MEDLINE, Scopus, Web of Science, and manually selected papers; the results of our own research were also used. An additional analysis of the results of examinations conducted in 1991–2004 was performed, which included a total of 11 123 persons irradiated as the result of catastrophy at the Chornobyl NPP. Results. In the first period of radiation cataract development, which is a specific consequence of radiation exposure, morphological changes (lens opacities) are observed, which lead to a decrease in visual function only later. Analysing the correlation between organic and functional changes in the development of diseases, for which ionising radiation exposure is a significant risk factor, we observe a similar picture. For example, CSVD associated with arterial hypertension may be a manifestation of accelerated aging associated with exposure to ionising radiation. Similarly, the initial signs of age-related macular degeneration in radiation-exposed individuals are usually manifested by changes in the morphology of the retina, choroid, and pigment epithelium in the macular area, while functional disorders in the form of decreased central vision and metamorphopsia, etc., occur later. Key words: Chornobyl disaster, ionising radiation, age-related macular degeneration, cataract, morphological changes, small vessel disease, neurocognitive deficit.