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Modern cataract surgery for radiation-induced cataracts in retinoblastoma
  1. Ihab M Osman1,
  2. Hana Abouzeid2,3,
  3. Aubin Balmer2,
  4. Marie-Claire Gaillard2,
  5. Philippe Othenin-Girard2,
  6. Alessia Pica4,
  7. Raphaël Moeckli5,
  8. Daniel F Schorderet3,6,
  9. Francis L Munier2,3
  1. 1Department of Ophthalmology, University of Alexandria, Egypt
  2. 2University of Lausanne, Jules-Gonin Eye Hospital, Lausanne, Switzerland
  3. 3University of Lausanne, IRO–Institute for Research in Ophthalmology, Sion, Switzerland
  4. 4University of Lausanne, Department of Radiation Oncology, CHUV, Lausanne, Switzerland
  5. 5University of Lausanne, Radiation Physics University Institute, Lausanne, Switzerland
  6. 6EPFL-Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
  1. Correspondence to Francis L Munier, Hôpital Ophtalmique Jules-Gonin, Ave de France 15 CH-1004 Lausanne, Switzerland; francis.munier{at}fa2.ch

Abstract

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.

  • Retinoblastoma
  • radiotherapy
  • brachytherapy
  • paediatric cataract surgery
  • radio-induced cataract
  • lens and zonules
  • retina
  • neoplasia
  • treatment other
  • child health (paediatrics)

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Footnotes

  • IMO and HA both equally contributed to this paper.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Swiss Federal Department of Health (authorization # 035.0003-48).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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