Modern cataract surgery for radiation-induced cataracts in retinoblastoma.
BACKGROUND
Surgery of radiation-induced cataracts in children with retinoblastoma (RB) is a challenge as early intervention is weighted against the need to delay surgery until complete tumour control is obtained. This study analyses the safety and functional results of such surgery.


METHODS
In a retrospective, non-comparative, consecutive case series, we reviewed medical records of RB patients ≤ 14 y of age who underwent either external beam radiotherapy or plaque treatment and were operated for radiation-induced cataract between 1985 and 2008.


RESULTS
In total, 21 eyes of 20 RB patients were included and 18 out of the 21 eyes had Reese-Ellsworth stage V or ABC classification group D/E RB. Median interval between last treatment for RB and cataract surgery was 21.5 months, range 3-164 months. Phacoaspiration was performed in 13 eyes (61%), extra-capsular cataract extraction in 8 (39%) and intraocular lens implantation in 19 eyes (90%). The majority of cases, 11/21 (52%), underwent posterior capsulorhexis or capsulotomy and 6/21 (28%) an anterior vitrectomy. Postoperative visual acuity was ≥ 20/200 in 13 eyes and < 20/200 in 5 eyes. Intraocular tumour recurrence was noted in three eyes. Mean postoperative follow up was 90 months ± 69 months.


CONCLUSIONS
Modern cataract surgery, including clear cornea approach, lens aspiration with posterior capsulotomy, anterior vitrectomy and IOL implantation is a safe procedure for radiation-induced cataract as long as RB is controlled. The visual prognosis is limited by initial tumour involvement of the macula and by corneal complications of radiotherapy. We recommend a minimal interval of 9 months between completion of treatment of retinoblastoma and cataract surgery.
Osman
Ihab M
IM
Hôpital Ophtalmique Jules-Gonin,Lausanne, Switzerland. francis.munier@fa2.ch
Abouzeid
Hana
H
Balmer
Aubin
A
Gaillard
Marie-Claire
MC
Othenin-Girard
Philippe
P
Pica
Alessia
A
Moeckli
Raphaël
R
Schorderet
Daniel F
DF
Munier
Francis L
FL
D000293:Adolescent; D002386:Cataract / Q000209:etiology*; D002387:Cataract Extraction / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003315:Cornea / Q000528:radiation effects; D005260:Female; D006801:Humans; D007908:Lens, Crystalline / Q000528:radiation effects; D008297:Male; D011184:Postoperative Period; D011832:Radiation Injuries / Q000150:complications / Q000601:surgery*; D019572:Retinal Neoplasms / Q000532:radiotherapy*; D012175:Retinoblastoma / Q000532:radiotherapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy