Radiation-induced cataract can be treated nine months after retinoblastoma therapy

This retrospective case series adds to the limited information about the optimal timing and expected outcome of surgery for radiation-induced cataracts in children treated for retinoblastoma. The results indicate that modern cataract surgery-including a clear corneal approach, lens aspiration with posterior capsulotomy, anterior vitrectomy and IOL implantation-is a safe treatment for radiation-induced cataract as long as retinoblastoma is controlled. The authors recommend waiting a minimum of nine months between the completion of retinoblastoma treatment and cataract surgery.

They reviewed medical records of 20 pediatric retinoblastoma patients (21 eyes) treated with external beam radiotherapy (EBR) or brachytherapy who subsequently underwent surgery for radiation-induced cataract at one hospital between 1985 and 2008. All eyes except for one underwent EBR and almost half of the cases underwent both EBR and brachytherapy.

The median interval between the last treatment for retinoblastoma and cataract surgery was 21.5 months (range, 3 to 164 months). Phacoaspiration was performed in 13 eyes (61 percent), extracapsular cataract extraction (ECCE) in eight (39 percent) and IOL implantation in 19 (90 percent). The majority of cases (11/21, 52 percent) underwent posterior capsulorhexis or capsulotomy, and 6/21 (28 percent) underwent anterior vitrectomy. Amblyopia treatment was performed when necessary.

The mean postoperative follow up was 90 months ± 69 months. Postoperative visual acuity was 20/20 in four eyes, between 20/20 and 20/200 in nine eyes and worse than 20/200 in five eyes. Intraocular tumor recurrence was noted in three eyes.

The authors say the results were not related to the use of different surgical approaches (limbal, sclera or corneal) or techniques (ECCE or phacoaspiration). They conclude that visual outcome was predominantly determined by preoperative tumoral macular involvement or radiation-induced complications. These complications were observed in all cases with visual acuity less than 20/20.