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

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 (logMAR), 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 radiation-inducedmaculopathy, 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 the12th month postoperatively (0.71) compared to baseline (1.14, p < 0.01). OCTmeasurements 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 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 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.