Surgical Outcomes in Radiation-induced Cataracts After External-beam Radiotherapy in Retinoblastoma

Abstract

Objectives:To investigate visual outcomes, surgical complications and tumor recurrence among children with retinoblastoma undergoing phacoemulsification and posterior chamber intraocular lens (PCIOL) implantation for radiation-induced cataract secondary to external beam radiotherapy.Materials and Methods:The medical records of all patients treated by phacoemulsification and PCIOL implantation for radiation-induced cataract after external beam radiotherapy for retinoblastoma at a single institution between 1980 and 2014 were reviewed retrospectively. The study included 6 eyes of 6 children (4 girls, 2 boys).Results:Four patients had bilateral and two patients had unilateral retinoblastoma. The median age at diagnosis of retinoblastoma was 28.3 months (range, 12-96 months). All patients received chemoreduction (OPEC protocol) and external beam radiotherapy with or without local ophthalmic therapies and developed radiation-induced cataracts. The median interval from retinoblastoma diagnosis to cataract surgery was 96.3 months (range, 73-122 months). Time interval between surgery and last retinoblastoma treatment was 67.2 months. Postoperative complications included iridocyclitis in 2 eyes and posterior capsule opacification in all eyes. The mean follow-up after surgery was 105.8 months (range, 59-120 months). Final visual acuity was better in all eyes than preoperative visual acuities.Conclusion:Phacoemulsification and PCIOL implantation is an effective method of managing radiation-induced cataracts in eyes with previously treated retinoblastoma. However, visual acuity was limited by the presence of primary macular tumor.

Cataract surgery in treated retinoblastoma eyes: A study of 29 eyes

“…However, literature reveals variation in the exact safety period between tumor regression and cataract surgery, surgical approach, preservation of posterior capsule, and safety of anterior vitrectomy in these cases. [13][14][15][16][17][18][19][20][21][22][23][24][25][26] The recommendations include tumor quiescent period of at least 12 to 18 months, clear corneal approach, and posterior capsule preservation whenever possible with or without PCIOL. [13][14][15][16][17][18][19][20][21][22][23][24][25][26] If posterior capsule is disrupted, cytology of the anterior vitrectomy sample provides evidence for active retinoblastoma.…”

“…[13][14][15][16][17][18][19][20][21][22][23][24][25][26] The recommendations include tumor quiescent period of at least 12 to 18 months, clear corneal approach, and posterior capsule preservation whenever possible with or without PCIOL. [13][14][15][16][17][18][19][20][21][22][23][24][25][26] If posterior capsule is disrupted, cytology of the anterior vitrectomy sample provides evidence for active retinoblastoma. 26 In our study, cataract surgery was done in all cases after a period of tumor quiescence for at least 6 months, 24 eyes had a period of tumor quiescence for at least 12 months, and 22 eyes had a period of tumor quiescence for at least 18 months.…”

“…A successful cataract surgery in a case of regressed RB allows vision salvage and globe salvage. [13][14][15][16][17][18][19][20][21][22][23][24][25][26] A large study of 42 treated RB eyes who underwent radiationinduced cataract extraction revealed vision salvage of 20/200 or better in 27 (64%) eyes and globe salvage in 40 (95%) eyes. 27 In our study, vision salvage of 20/200 or better was achieved in 12 (41%) eyes and globe salvage in 26 (90%) eyes.…”