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Post-Radiation Cataract Management: Outcomes in Individuals with Uveal Melanoma

  • Cataract and Refractive Surgery (E Otero, Section Editor)
  • Published:
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Abstract

Purpose of review

To report the visual, clinical, and surgical outcomes of cataract surgery following radiation therapy for uveal melanoma (UM) while reviewing the available literature discussing these outcomes.

Recent Findings

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. 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%), sub-tenon’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 µm) during the 6th postoperative month compared to baseline (327 µm; p < 0.01).

Summary

Cataract surgery is safe and effective in improving visual acuity in individuals with post-radiation cataracts. Routine macular thickness monitoring should be considered in order to optimize their visual outcome. In the treatment of these patients, a multidisciplinary approach and proper surgical planning are essential, with a focus on early, aggressive anti-inflammatory 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%), sub-tenon’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 µm) during the 6th postoperative month compared to baseline (327 µm; 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.

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Funding

Supported by the NIH Center Core Grant P30EY014801, Research to Prevent Blindness Unrestricted Grant (GR004596) to Bascom Palmer Eye Institute and Consejo Nacional de Ciencia y Tecnología CVU810654 (H. Levine).

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Authors and Affiliations

  1. Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17Th St, Miami, FL, 33136, USA

    Paula A. Sepulveda-Beltran, Harry Levine, Zelia M. Correa & Guillermo Amescua

  2. Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 3880, Tamiami Trail N, Naples, FL, USA

    Allister G. Gibbons & Jaime D. Martinez

  3. Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 7101, Fairway Dr, Palm Beach Gardens, FL, USA

    Arindel Maharaj

  4. Cataract & Vision Center of Hawaii, Honolulu, HI, USA

    Daniel S. Choi

  5. Department of Ocular Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA

    Zelia M. Correa

  6. Department of Ophthalmology, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA

    J. William Harbour

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  1. Paula A. Sepulveda-Beltran
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Correspondence to Guillermo Amescua.

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Meeting Presentations: Abstract presented at: Women In Ophthalmology Summer Symposium; August 26–29, 2021; Amelia Island, FL, USA. Abstract presented at: ASCRS annual meeting; April 22–26, 2022; Washington, DC, USA.

This article is part of the Topical Collection on Cataract & Refractive Surgery.

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Sepulveda-Beltran, P.A., Levine, H., Gibbons, A.G. et al. Post-Radiation Cataract Management: Outcomes in Individuals with Uveal Melanoma. Curr Ophthalmol Rep 10, 218–227 (2022). https://doi.org/10.1007/s40135-022-00304-5

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