Outcomes of paediatric cataract surgery following Proton Beam Radiotherapy (PBRT) for Orbital Rhabdomyosarcoma (RMS)

Session Details

Session Title: Presented Poster Session: Cataract Complications & Special Cases

Venue: Poster Village: Pod 1

First Author: : D.Jackson UK

Co Author(s): :    K. Aggarwal   J. Norris   D. Hildebrand                 

Abstract Details

Purpose:

RMS is the most common paediatric soft tissue sarcoma and has an excellent prognosis with a survival rate of greater than 85%. PBRT is increasingly used to treat patients with orbital RMS, theoretically sparing normal tissues with fewer side-effects than conventional radiotherapy. Visually threatening complications from PBRT have been reported in adults, including cataracts and glaucoma. There is a lack of data on management of paediatric cataract and outcomes of paediatric cataract surgery following orbital PBRT. We report our experience and outcomes of cataract surgery in children treated with PBRT for orbital RMS.

Setting:

Single paediatric tertiary referral centre (Oxford University Hospitals NHS Foundation Trust, UK)

Methods:

Retrospective case series of all children seen at our institution with a diagnosis of orbital RMS and who received PBRT. Preoperative and intraoperative details, complications and visual outcomes were extracted from medical records for the period between September 2010 and February 2018.

Results:

Four patients received PBRT for orbital RMS, median age diagnosis 6 years (0.5-7 years). Median follow-up period was 3.5 years (1-7 years). Three required cataract surgery, median interval post-PBRT 2.5 years (2-2.5 years). Primary IOL insertion was performed in all cases: two in bag and one in sulcus. Two developed posterior capsular opacification at 8 and 10 months, successfully treated with YAG capsulotomy. Long-term visual acuity for two patients was logMAR0.00 and 0.325. The third case just commenced occlusion therapy post-surgery. Management was effected by pre-existing ocular surface disease. No patients developed secondary glaucoma, retinopathy or neuropathy to date.

Conclusions:

We report the first case series detailing technical aspects and outcomes of cataract surgery in children post PBRT for orbital RMS. Cataract was a common complication in our cohort, with 75% requiring surgery at a median interval of 2.5 years post PBRT. There are significant challenges associated with paediatric cataract surgery, particularly in post-radiation eyes. Technical challenges arise from compromised ocular surfaces and fragile capsules. Careful management can still result in excellent outcomes, as we demonstrate. Larger and longer-term data are required on the management of cataract in these patients and visual outcomes as PBRT becomes more available.

Financial Disclosure:

None