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C. A. Galvan, S. J. Frank, L. Bailey, V. Arevalo, S. K. Kim; External Beam Radiation-Induced Cataract Experience From Tertiary Cancer Center. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5568.
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There is paucity of data for cataract surgery (CS) outcome studies in patients who had external radiotherapy (XRT) above the neck, though it is generally accepted that post-irradiated eyes have higher complications with cataract surgery. The purpose of this study is to describe the cataract surgery experience in patients who received external beam XRT, spanning the neck region to the brain for a variety of cancers.
An IRB-approved, retrospective review of cataract surgery performed in patients with above criteria at MDACC between 1/00 and 6/08 was conducted. Patients’ medical and radiation history, and ophthalmic history (pre/ post-cataract surgery) were collected. Literature search was performed for CS after external beam XRT.
89 eyes from 58 patients were evaluated. Of them, XRT treatment breakdown was as follows: whole brain-20 (22.0%); brain stereotactic-3 (3.3%), total body irradiation-13 (15.4%), skull-4 (5.5%), neck-5 (5.5%), head & neck-28 (30.8%), and orbital-16 (22.0%). Patients’ diagnoses included orbital metastatic disease, lymphoma, brain tumor, and a variety of head and neck cancers. Total radiation dose averaged 40.6 Gy (range: 2-116 Gy). Median pre-operative visual acuity (VA) was 20/100 ranging from 20/40 to HM. Preop diagnoses included late effects of XRT (ocular surface disease, retinopathy, optic neuropathy). Post-operatively, 95.5% (N=85 eyes) of patients had better vision postop compared to preop, with 75 eyes (84.2%) with visual acuity of 20/30 or better, with average follow-up was 12.7 months. The most common perio-operative complication was posterior capsular tears (PCT), (in eyes with average XRT dose=36.3 Gy) and subset analysis revealed that orbital XRT group had the worst outcome with progression of radiation induced retinopathy and optic neuropathy. Posterior capsular haze, often seen post external XRT, was commonly observed in orbital XRT patients, (10 eyes, 62.5%) at the time of surgery.
To our knowledge, this is the first study to analyze cataract surgical outcomes in patients with history of external XRT in the head and neck, brain, and orbit region for a variety of cancers. Subset analysis demonstrated orbital irradiated patients had a worse visual outcome when compared to other patients. History of XRT may result in higher peri-operative complication, and may increase XRT induced toxicity post-operatively. Patients with history of XRT should be adequately counseled prior to surgery. Future studies are on-going to better elucidate these conclusions.
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