Lenticular Changes Associated with Beta Radiation of the Eye and Their Significance

Thomas, Charles I.; Storaasli, John P.; Friedell, Hymer L.

doi:10.1148/79.4.588

Cited by 35 publications

(6 citation statements)

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“…Despite a larger dose of radiation to the lens, cataract is not common. Finally, radiation induced cataract is a characteristic pattern of cortical opacity, starting at the site of application 28. This pattern was not observed in our patients.…”

Section: Discussioncontrasting

confidence: 41%

Effect of β radiation on success of glaucoma drainage surgery in South Africa: randomised controlled trial

Kirwan

Cousens

Venter³

et al. 2006

BMJ

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Objective To evaluate whether radiation may offer a practical method of improving surgical success for glaucoma drainage surgery in South Africa. Design Double blind, randomised controlled trial. Setting Three public hospitals in South Africa. Participants 450 black Africans with primary glaucoma. Interventions Trabeculectomy with 1000 cGy radiation or standard trabeculectomy without radiation (placebo). Main outcome measures Primary outcome measure was surgical failure within 12 months (intraocular pressure > 21 mm Hg while receiving no treatment for ocular hypotension). Secondary outcomes were visual acuity, surgical reintervention for cataract, and intraoperative and postoperative complications. Results 320 people were recruited. radiation was given to 164; 20 (6%) were not seen again after surgery. One year after surgery the estimated risk of surgical failure was 30% (95% confidence interval 22% to 38%) in the placebo arm compared with 5% (2% to 10%) in the radiation arm. The radiation group experienced a higher incidence of operable cataract (18 participants) than the placebo group (five participants; P = 0.01). At two years the estimated risks with placebo and radiation were, respectively, 2.8% (0.9% to 8.3%) and 16.7% (10.0% to 27.3%). Conclusion radiation substantially reduced the risk of surgical failure after glaucoma surgery. Some evidence was, however, found of an increased risk for cataract surgery (a known complication of trabeculectomy) in the radiation arm during the two years after surgery. Trial registration ISRCTN62430622.

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Section: Discussioncontrasting

confidence: 41%

Effect of β radiation on success of glaucoma drainage surgery in South Africa: randomised controlled trial

Kirwan

Cousens

Venter³

et al. 2006

BMJ

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“…Radiation-induced cataract has a characteristic pattern of cortical opacity, starting at the site of application (29) , which was not observed in the patients of those studies.…”

Section: Discussionmentioning

confidence: 71%

Meta-analysis of beta radiation augmentation for trabeculectomy - results in distinct ethnic groups

Fendi

Arruda

Costa

et al. 2011

Arq. Bras. Oftalmol.

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RESUMO Objetivo: Realizar uma revisão sistemática com meta-análise sobre a eficácia da trabeculectomia (TREC), seguida ou não por irradiação beta (BRT/TREC) para o tratamento do glaucoma, em termos de controle da pressão intraocular (PIO) e de efeitos adversos citações, oito estudos (cinco coortes e três aleatorizados) foram identificados e apenas 3 RCT foram incluídos nesta meta-análise. Maiores reduções na PIO foram verificadas no braço de estudo da BRT, comparado com o braço controle (diferença média=1,68 mmHg, 95% CI= 0,61-2,68, P=0,002). A frequência de PIO pós-operatória não controlada (>21 mmHg) foi menor quando utilizada a BRT (BRT/TREC) em relação ao grupo controle (38/218 =17,4% versus 9/239 =3,8%;OR= 6,7 IC 95% 3,2 14,3, P<0,0001 ABSTRACTPurpose: To conduct a systematic review with meta-analysis on the efficacy of trabeculectomy (TREC) followed by beta irradiation (BRT/TREC) compared to TREC alone for glaucoma in terms of intraocular pressure (IOP) control and adverse effects of treatment in different ethnic groups. Methods: A meta-analysis of randomized controlled trials (RCT) was performed comparing adjunct BRT treatment for glaucoma with standard TREC after 12 months. The MEDLINE, EMBASE, LILACS, and Cochrane Library databases, Trial registers, bibliographic databases and recent studies of relevant journals were searched. Two reviewers independently reviewed relevant reports and the references from these reports were searched for additional trials, using guidelines set by QUOROM statement criteria. Results: Of a total of 1,350 citations, eight studies (five cohorts, three randomized) were identified and only 3 RCT were included in this meta-analysis. Higher IOP reductions were verified in the BRT arm compared to the control arm (mean difference=1.68 mmHg, 95% CI= 0.61-2.68, P=0.002). Uncontrolled postoperative IOP (>21 mmHg) was less frequent when BRT was used (BRT/ TREC arm) compared to the control arm (38/218=17.4% versus 9/239=3.8%; OR=6.7; 95% CI 3.2-14.3, P<0.0001). Although better IOP control was observed in all patients treated with adjuvant BRT, only Black patients displayed a significant difference (P=0.005). There were no significant differences between the BRT and control arms regarding loss of visual acuity, postoperative complications and necessity of cataract surgery. Conclusion: Adjunct BRT increases the success rate of TREC, with better results in non Caucasian patients, and does not influence the occurrence of postoperative complications.

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“…Many clinical and experimental studies have been published investigating the tolerance of the lens to radiation. [20][21][22] Cataracts have not been reported with lens doses of radiation below 200 cGy, but nonprogressive lens changes have been sporadically recorded with doses just above this level. Merriam et al 23 concluded that the minimum cataractogenic dose for a single treatment was 200 cGy to the lens epithelium, with the probability of cataract approaching unity for a dose of 750 cGy, although only 50% of these cases showed progressive change.…”

Section: Radiation and The Lensmentioning

confidence: 99%

“…Dose to the lens has been calculated assuming exponential decay of the surface dose. Using 21,22 Cataract (50% progressive) 21,22 Retina 1500 cGy 77 8-24 days Mild radiation retinopathy rarely reported (single report) 77 3000 cGy 49 >6 months Higher risk of radiation retinopathy 49 more sophisticated modelling, Gleckler et al 24 estimated that the dose to the germinative epithelium is approximately 14% of the surface dose applied after pterygium surgery onto the bare sclera. The additional attenuation by the conjunctiva with a thickness of approximately 1 mm means that the lens dose following application after trabeculectomy is likely to be less than 10%.…”

Section: Radiation and The Lensmentioning

confidence: 99%

Beta irradiation: new uses for an old treatment: a review

Kirwan¹,

Constable

Murdoch

et al. 2003

Eye

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Beta radiation has a long history as a treatment modality in ophthalmology. It is a convenient and practical method of applying radiation and has the advantage of minimal tissue penetration. There has been a recent resurgence in the use of beta radiation in other areas in medicine, such as the prevention of restenosis after coronary artery stenting. Beta radiation has been shown in vitro and in vivo to inhibit proliferation of human Tenon's fibroblasts, which enter a period of growth arrest but do not die. Effects on the cell cycle controller p53 have been shown to be important in this process.In ophthalmology, beta radiation has been used widely for the treatment of pterygium and is under evaluation for treatment of agerelated macular degeneration and for controlling wound healing after glaucoma drainage surgery. In this latter role, beta radiation may be particularly appropriate for use in developing countries to improve the results of trabeculectomy while potentially avoiding some of the side effects of other antimetabolites.

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Lenticular Changes Associated with Beta Radiation of the Eye and Their Significance

Cited by 35 publications

References 0 publications

Effect of β radiation on success of glaucoma drainage surgery in South Africa: randomised controlled trial

Effect of β radiation on success of glaucoma drainage surgery in South Africa: randomised controlled trial

Meta-analysis of beta radiation augmentation for trabeculectomy - results in distinct ethnic groups

Beta irradiation: new uses for an old treatment: a review

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