Cataract Surgery and Intraocular Lens Implantation in Patients With Retinoblastoma

Abstract

To report the visual outcome and complications after extracapsular cataract extraction with posterior chamber intraocular lens (IOL) implantation in eyes that underwent external beam radiotherapy for the treatment of retinoblastoma. Methods: Eleven eyes of 8 patients aged 1.5 to 8.0 years at the time of surgery for irradiation-induced cataract were observed for 6 to 39 months (mean [±SD], 20±10 months). A standard technique of extracapsular cataract extraction, posterior chamber IOL implantation, pars plana posterior capsulotomy, and pars plana anterior vitrectomy was performed in 9 eyes, and secondary IOL placement was performed in 2 eyes. Results: All eyes that underwent primary IOL implantation achieved visual acuities equal to or better than those best ever recorded prior to the development of the cataract. There were no postoperative complications, and all eyes experienced minimal postoperative inflammation. The 2 eyes that underwent secondary IOL implantation achieved their best-corrected aphakic visual acuities but experienced a prolonged course of postoperative inflammation. Conclusion: Intraocular lens placement in the posterior chamber of eyes with regressed retinoblastoma and irradiation-induced cataract seems to be a safe and effective method for the correction of aphakia.

Modern cataract surgery for radiation-induced cataracts in retinoblastoma

“…In the present study, postoperative inflammation was moderate in children receiving radiation therapy. This was also noted by Portellos and Buckley in their 11 cases study and was attributed to the destruction by the radiotherapy of the antigenic lens proteins and cells 20. In contrast with studies in which pars plana lensectomy was the predominant surgical technique performed,21–24 we did not observe any case of postoperative retinal detachment.…”

Phacoemulsification and foldable acrylic IOL implantation in children with treated retinoblastoma

“…Same authors (15) reported a series of eleven eyes that underwent a primary IOL implantation after RB treatment. They concluded that IOL implantation seemed to be a safe method for aphakia correction.…”

“…They concluded that IOL implantation seemed to be a safe method for aphakia correction. The authors advised penetrating the anterior chamber through a clear corneal incision to avoid direct contact with conjunctival blood vessels, scleral tissues, and vitreous management in order to reduce the risk of spreading tumoral cells (15) . Besides tumoral spread or recurrences, the complications expected in the removal of radiation-induced cataracts are similar to pediatric cataract surgery (3,9,(16)(17) .…”

Cataract Surgery in Retina Patients

“…Studies have shown that cataract surgery in patients who have previously received radiation therapy for retinoblastoma is generally not associated with tumor recurrence or spread (Brooks et al, 1990;Portellos and Buckley, 1998). Controversies in cataract management include the surgical approach, the management of the posterior capsule and anterior vitreous.…”