Cataract surgery after proton-beam irradiation for uveal tumors

To study the risks associated with cataract surgery in patients with previous proton-beam irradiation (PBI), focusing on preoperative risk factors, intraoperative findings, and postoperative complications.

Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA.

Retrospective case series.

Electronic medical records of patients who had PBI and cataract surgery between January 1, 2006, and October 1, 2016, were reviewed.

The study comprised 29 eyes of 29 patients. Preoperative evaluation found dry eye (72.4%), posterior synechiae (24.1%), peripheral anterior synechiae (13.8%), anterior capsule fibrosis (10.3%), and iris atrophy (10.3%). Intraoperative findings included poor red reflex requiring trypan blue capsule staining (37.9%), synechiae requiring synechialysis (24.1%), evidence of previous inflammation prompting sub-Tenon triamcinolone injection (17.2%), and miosis (10.3%). Postoperative complications included posterior capsule opacification (PCO) by 1 year (48.3%), intraocular pressure spike of 23 mm Hg or greater at 1 day (24.1%), anterior chamber inflammation at 1 month (24.1%), and cystoid macular edema (CME) (17.2%). Proximity of the initial tumor to the posterior pole was associated with poor visual outcomes after cataract surgery. Compared with reference data, this cohort had higher rates of anterior chamber inflammation at 1 month, CME, fibrinous inflammation, PCO by 1 year, intraoperative requirement for trypan blue, and synechialysis.

Complications after cataract surgery performed after PBI were similar to those seen in patients with uveitis (prolonged inflammation, CME, fibrinous inflammation, early PCO). Steroid depot administration might be useful to prevent these complications, although further research is needed to determine an optimum regimen.