Radiotherapy and Cataract Formation

Uveal melanoma has traditionally been treated with enucleation, plaque brachytherapy, or external beam radiation. Following the results of the multicenter Collaborative Ocular Melanoma Study (COMS), which established no significant difference in mortality rates between enucleation and brachytherapy, plaque brachytherapy has become the favoured modality given its potential for preservation of vision and the eye. Among the radioisotopes that have been used, iodine-125 (I-125) has become the increasingly popular choice in the United States. However, I-125 brachytherapy is associated with complications, including keratitis, iris neovascularization, neovascular glaucoma, radiation retinopathy, and optic neuropathy. The purpose of this review is to discuss the pathogenesis, clinical presentation, and management of complications related to I-125 plaque brachytherapy for choroidal melanoma.

show abstract

“…Radiation exposure may also lead to the development of cortical cataract or exacerbate existing nuclear sclerotic cataract. 26 …”

Section: Eyementioning

confidence: 99%

Ocular complications following I-125 brachytherapy for choroidal melanoma

Wen

Oliver

McCannel

2009

Eye

View full text Add to dashboard Cite

show abstract

“…Despite its high local control rate, many studies have reported that radiation can induce complications such as cataracts, keratitis, dry eye syndrome, and retinopathy [1,5-8]. The lens of the eye is a radiosensitive structure [7]. It is well established that ionizing radiation exposure damages the dividing cells of the crystalline lens; differentiation and migration of the damaged cells to the posterior pole leads to posterior lens opacifications [7,9].…”

mentioning

confidence: 99%

“…The lens of the eye is a radiosensitive structure [7]. It is well established that ionizing radiation exposure damages the dividing cells of the crystalline lens; differentiation and migration of the damaged cells to the posterior pole leads to posterior lens opacifications [7,9]. Cataracts can be induced by a single dose of <2 Gy, or 4 to 5.5 Gy in a fractionated dose, and toxicity is more common with doses >36 Gy [4-6,10-12].…”

mentioning

confidence: 99%

Risk Potentiality of Frontline Radiotherapy Associated Cataract in Primary Ocular Adnexal Mucosa-associated Lymphoid Tissue Lymphoma

Cho

Lee

Paik

et al. 2013

Korean J Ophthalmol

View full text Add to dashboard Cite

PurposeTo elucidate risk potentiality of frontline radiotherapy associated cataracts in primary ocular adnexal mucosa-associated lymphoid tissue lymphoma (OAML).MethodsData from eight consecutive patients of 41 total OAML patients who had undergone cataract surgery after frontline radiotherapy were analyzed.ResultsThe median patient age was 46 years (range, 36 to 69 years). The median total radiation dose was 3,780 cGy (range, 3,060 to 4,500 cGy), and the mean duration from radiation irradiation to cataract surgery was 36.60 ± 8.93 months. Preoperative lens opacification was primarily at the posterior lens subcapsule, and best-corrected visual acuity (BCVA) was 0.43 ± 0.21. Patients underwent the phacoemulsification surgical procedure with posterior chamber intraocular lens insertion. The average BCVA improved to 0.90 ± 0.14 after cataract surgery. Two patients underwent posterior continuous curvilinear capsulorhexis, and one had posterior capsule rupture. For posterior capsule opacification (PCO), three patients received Nd:YAG laser posterior capsulotomy after the initial surgery, and one patient is currently under consideration for laser posterior capsulotomy.ConclusionsRadiotherapy increased posterior subcapsule opacification at a relatively young age in primary OAML. Phacoemulsification was a manageable procedure without severe complications, and final visual outcomes were good. However, because after-cataracts progressed earlier than did senile cataracts, close follow-up should be considered for PCO management.

show abstract

“…Major risk factors include ocular trauma, intraocular surgery, diabetes mellitus, corticosteroid use, and radiation exposure [16, 18]. In the past few decades, excessive doses of ionizing radiation have also been documented to induce opacities in eye lenses [19, 20]. Recent studies from atomic bomb survivors, Chernobyl clean-up workers, and residents of radiationcontaminated buildings have shown that the threshold radiation dose for inducing lens opacity is lower than that previously reported [6, 21, 22].…”

Section: Discussionmentioning

confidence: 99%

The risk of cataractogenesis after gamma knife radiosurgery: a nationwide population based case-control study

et al. 2017

View full text Add to dashboard Cite

BackgroundMedical radiation is considered a factor responsible for cataractogenesis. However, the incidence of this ophthalmologic complication resulting from gamma knife radiosurgery (GKRS) has not yet been reported. The present study aimed to determine the risk of cataractogenesis associated with radiation exposure from GKRS.MethodsThis study used information from a random sample of one million persons enrolled in the nationally representative Taiwan National Health Insurance Research Database. The GK group consisted of patients who underwent GKRS between 2000 and 2009. The non-GK group was composed of subjects who had never undergone GKRS, but who were matched with the case group for time of enrollment, age, sex, history of coronary artery disease, hypertension, and diabetes.ResultsThere were 277 patients in the GK group and 2770 matched subjects in the non-GK group. The GK group had a higher overall incidence of cataracts (10.11% vs. 7.26%; crude hazard ratio [cHR], 1.59; 95% CI, 1.07–2.36; adjusted hazard ratio [aHR], 1.25; 95% CI, 0.82–1.90) than the non-GK group. Patients who had undergone computed tomography and/or cerebral angiography (CT/angio) studies had a higher risk of developing cataracts than those who did not (10.82% vs. 6.64%; cHR, 1.74; 95% CI, 1.31–2.30; aHR, 1.65; 95% CI, 1.22–2.23). The age group between 30 and 50 years had the highest risk of cataractogenesis in both the GK and CT/angio groups (cHR, 3.50; 95% CI, 1.58–7.72; aHR, 2.43; 95% CI, 1.02–5.81; cHR, 2.96; 95% CI, 1.47–5.99; aHR, 2.27; 95% CI, 1.05–4.93, respectively).ConclusionsRadiation exposure due to GKRS and CT/angio study may be independently associated with increased risk of cataractogenesis. We suggest routine dosimetry measurement of eye lens and proper protection for patients with benign lesions during GKRS. Regular follow-up imaging studies should avoid the use of CT/angio, and particular care should be taken in the 30–50-year-old age group, due to their significantly increased risk of cataract formation.

show abstract

Radiotherapy and Cataract Formation

Cited by 34 publications

References 37 publications

Ocular complications following I-125 brachytherapy for choroidal melanoma

Ocular complications following I-125 brachytherapy for choroidal melanoma

Risk Potentiality of Frontline Radiotherapy Associated Cataract in Primary Ocular Adnexal Mucosa-associated Lymphoid Tissue Lymphoma

The risk of cataractogenesis after gamma knife radiosurgery: a nationwide population based case-control study

Contact Info

Product

Resources

About