Posters

Radiation-induced cataract among children treated for retinoblastoma: assessment for postoperative vision and complications

Poster Details

First Author: S.Chandramouli INDIA

Co Author(s):    K. Narendran   A. Dhage                 

Abstract Details

Purpose:

Treatment of retinoblastoma has seen a world of change. Chemoreduction and external beam radiotherapy have changed the way advanced retinoblastoma is managed. But these modalities have brought their own set of complications. One such complication is radiation induced cataract, which occurs in patients receiving EBRT. We have retrospectively assessed patients with radiation induced cataract and described cataract extraction through a corneo-scleral tunnel with or without intraocular lens implantation with posterior capsulotomy and anterior vitrectomy.Our study aims to investigate mean interval for cataract development, visual outcomes, surgery related complications and reactivation of tumour post cataract extraction in children treated for retinoblastoma

Setting:

Aravind Eye Hospital , Avinashi Road , Coimbatore

Methods:

The case records of 856 children with a diagnosis of retinoblastoma from Jan 2006 to Dec 2015 were retrospectively reviewed.13 eyes of 11 patients met the inclusion criteria , all had received EBRT for advanced retinoblastoma. Duration from completion of EBRT to first clinical evidence of cataract was noted. Also interval from cataract detection to cataract surgery was noted. . A minimum of 8 months of tumour inactivity was recorded before posting for surgery. Post-operative visual acuity assessment and thorough fundus examination was done at 15 days, 30 days and 3 months.

Results:

10 cases were of bilateral retinoblastoma and only a single case was of unilateral tumour. 3 had developed bilateral cataracts.The mean interval from diagnosis of retinoblastoma to first evidence of clinical lenticular opacity was 30 months. The mean interval from completion of EBRT to cataract detection was 18.6 months.BCVA was recorded at 3 months post cataract surgery. 61.5%developed visual acuity >6/18. 23.07%- 6/18 to 3/60 and 15.38% had < 3/60. None of the patients developed reactivation of primary tumour/ metastasis or extra-ocular extension in a follow up period of not < 18 months.

Conclusions:

Radiation induced cataract can be managed safely and effectively with corneo-scleral tunnel /posterior capsulotomy and anterior vitrectomy. Children receiving EBRT are likely to develop cataract in a period of 18.6 months. No reactivation or spread of tumour was noticed in a minimum follow up of 18 months. Gain in visual acuity is satisfactory if tumour has not involved fovea. Considering limitations of the study, we recommend our approach for such patients as it is simple to perform and does not need introduction of a pars plana port. Further follow up of these patients is necessary for any long term complications.

Financial Disclosure:

None