Pars plana lensectomy and intraocular lens implantation in pediatric radiation-induced cataracts in retinoblastoma.
OBJECTIVE
To investigate visual outcomes, surgical complications, and tumor recurrence among children with retinoblastoma (RB) undergoing pars plana lensectomy, vitrectomy, and simultaneous intraocular lens insertion for radiation-related cataract secondary to external beam radiotherapy (EBRT).


METHODS
Retrospective, noncomparative, consecutive case series.


METHODS
The medical records for all patients treated with pars plana lensectomy, vitrectomy, and posterior chamber intraocular lens implantation for radiation-induced cataract after EBRT for RB at a single institution between January 1, 1990, and December 31, 2000, were reviewed.


METHODS
The study included 16 eyes of 12 children with Reese-Ellsworth stage V RB.


METHODS
Visual acuity, surgical and postoperative complications, postoperative refraction, and tumor recurrence.


RESULTS
The median age at diagnosis of RB was 6 months (range, 1-49 months). All patients received EBRT as primary treatment and experienced radiation-induced cataracts. The median interval from RB diagnosis to cataract surgery was 42 months (range, 28-95 months). Preoperative mean visual acuity was 20/400, with 12 of 16 eyes (75%) having macular tumor involvement. All patients underwent pars plana lensectomy, vitrectomy, and posterior chamber intraocular lens insertion. Vitreous samples were evaluated by cytopathologic examination, and no viable tumor cells were identified in any of the vitreous specimens. Postoperative complications included transient cystoid macular edema in 5 eyes (31%) and iridocyclitis in 3 eyes (19%). The mean follow-up after cataract surgery was 66 months (range, 30-94 months). Final visual acuity was 20/40 or better in 11 of 16 eyes (69%). No late intraocular recurrence, orbital tumors, or metastatic disease was noted in this study.


CONCLUSIONS
Pars plana lensectomy, vitrectomy, and simultaneous intraocular lens implantation is an effective means of managing EBRT-induced cataracts in eyes with previously treated RB. There was no evidence of active tumor in eyes undergoing surgery at least 28 months after the diagnosis and commencement of therapy for RB, and no late intraocular, orbital, or metastatic tumors were detected. Visual acuity was limited by the presence of primary macular tumor pathologic features in a subset of patients, but final vision better than 20/400 may be achieved in these eyes.
Miller
Daniel M
DM
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida 33101, USA.
Murray
Timothy G
TG
Cicciarelli
Nicole L
NL
Capo
Hilda
H
Markoe
Arnold M
AM
D002386:Cataract / Q000209:etiology*; D002387:Cataract Extraction; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D019654:Lens Implantation, Intraocular; D007908:Lens, Crystalline / Q000528:radiation effects*; D008297:Male; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications; D011832:Radiation Injuries / Q000209:etiology*; D019572:Retinal Neoplasms / Q000532:radiotherapy*; D012175:Retinoblastoma / Q000532:radiotherapy*; D012189:Retrospective Studies; D014792:Visual Acuity; D014821:Vitrectomy