RADIATION-INDUCED CATARACT IN A RADIOLOGY HEALTH PROFESSIONAL.

Cataract is defined as an opacification of the lens leading to a decrease in visual acuity. Among the etiologies of cataracts, the action of ionizing radiation, known for a century, constitutes an original entity.

We report a case of radiation-induced cataract in a radiology health professional to describe its pathogenesis, its clinical aspect in order to prevent it.

We report the case of a 38-year-old radiology staff with no particular history who consulted for a progressive decline in visual acuity in his right eye.

The ophthalmological examination finds: A visual acuity of 6/10 in his right eye rising to 10/10 after correction, and an acuity of 10/10 in the left eye.

The slit lamp examination shows in the right eye: A clear cornea, a normal anterior chamber and a posterior subcapsular cataract.The rest of the exam is unremarkable.

Given his good corrected visual acuity, the patient is fitted with corrective lenses. Phacoemulsification surgery with placement of an intraocular implant will be considered depending on the evolution.

The pathogenesis of radiation-induced cataract would be less of the deterministic type (direct tissue damage killing or seriously damaging a given cell population), but more of the stochastic type (alteration of the genome of the target cells, disruption of cell division, disorder of cell differentiation of daughter cells).

Regarding the minimum dose likely to cause a radiation-induced cataract In 1950, Merriam proposed a range between 5 and 15 Grays (Merriam and Worgul, 1983)

In 1957, they proposed a threshold of 2 Gy for a single dose and 4 Gy for a dose divided and/or spread over time (Merriam and Focht, 1957).

For the Time to onset, it can vary between 6 months and 35 years; the average would be around 2 to 3 years (Merriam and Worgul, 1983).

From the point of view of radiation protection regulations, the Labor Code stipulates that: “for the lens, the exposure received during twelve consecutive months cannot exceed 150 mSv” (Labour Code, 2008).

A worker is considered to be at risk insofar as he is likely to receive an equivalent dose to the lens of more than 15 mSv per year (“public” dose). This is particularly the case for certain hospital staff, particularly in interventional radiology.

In addition to implementing conventional protection measures against ionizing radiation, interventional radiologists and other professionals assisting them are strongly recommended to systematically wear lead-glass glasses, since they reduce the dose received by 80%. These lead glasses can be adapted to the view

Ophthalmologists have an important role to play in encouraging people to wear protective glasses, but also, competent persons in radiation protection and occupational physicians.