Abstract
Purpose of review To report the visual, clinical, and surgical outcomes of cataractsurgery following radiation therapy for uveal melanoma (UM) while reviewing theavailable literature discussing these outcomes.
Recent Findings Patients were managed with cataractsurgery after radiation for UM at the Bascom Palmer Eye Institute, betweenJanuary 2014 and February 2021, with a minimum follow-up of 6 months. Only theradiated eye was included. Measured outcomes included BCVA (1ogMAR), and OCTmeasurement of macular thickness at 1, 3, 6, and 12 months postoperatively.Paired t-tests were used to compare pre- and postoperative variables.Forty-seven eyes from 47 patients were included. Their mean age was 67.0 +/- 11.0years old; 24 (51%) were male. Preoperatively, 21 (44.6%) had radiationinducedmaculopathy, 8 (17%) exudative retinal detachment, and 4 (8.5%) iris synechiae.Cataract types included nuclear sclerosis (80.8%), posterior subcapsular(55.3%), cortical sclerosis (19.1%), and mixed-type (55.3%). Intraoperativeevents reported were synechialysis (4.2%), floppy iris syndrome (IFIS) (2.1%),sub-tenon's corticosteroid injections (31.9%), and bevacizumab (21.2%). Therewere no complications. There was a significant improvement in best correctedvisual acuity (BCVA) at the 1st month postoperatively (0.68), and up until thel2th month postoperatively (0.71) compared to baseline (1.14, p < 0.01). OCTmeasurements of the macular thickness showed a significant increase (363 um)during the 6th postoperative month compared to baseline (327 um; p < 0.01).
Summary Cataract surgery is safe and effectivein improving visual acuity in individuals with post-radiation cataracts. Routine macular thickness monitoring should be considered in order to optimizetheir visual outcome. In the treatment of these patients, a multidisciplinaryapproach and proper surgical planning are essential, with a focus on early,aggressive antiinflammatory and anti-VEGF therapy.
Setting Bascom Palmer Eye Institute, USA.
Design Retrospective chart review.
Methods Patients were managed with cataract surgery after radiation for UM at the Bascom Palmer Eye Institute, between January 2014 and February 2021, with a minimum follow-up of 6 months. Only the radiated eye was included. Measured outcomes included BCVA (logMAR) and OCT measurement of macular thickness at 1, 3, 6, and 12 months postoperatively. Paired t-tests were used to compare pre and postoperative variables.
Results Forty-seven eyes from 47 patients were included. Their mean age was 67.0 +/- 11.0 years old; 24 (51%) were male. Preoperatively, 21 (44.6%) had radiation-induced maculopathy, 8 (17%) exudative retinal detachment, and 4 (8.5%) iris synechiae. Cataract types included nuclear sclerosis (80.8%), posterior subcapsular (55.3%), cortical sclerosis (19.1%), and mixed-type (55.3%). Intraoperative events reported were synechialysis (4.2%), floppy iris syndrome (IFIS) (2.1%), subtenon's corticosteroid injections (31.9%), and bevacizumab (21.2%). There were no complications. There was a significant improvement in best corrected visual acuity (BCVA) at the 1st month postoperatively (0.68) and up until the 12th month postoperatively (0.71) compared to baseline (1.14, p < 0.01). OCT measurements of the macular thickness showed a significant increase (363 mu m) during the 6th postoperative month compared to baseline (327 mu m; p < 0.01).
Conclusion Cataract surgery is safe and effective in improving visual acuity in individuals with post-radiation cataracts. A multi-disciplinary approach, proper surgical planning, and postoperative anti-inflammatory care are paramount in the management of these individuals.
