Cataract Surgery Following Proton Therapy For Intra-Ocular Melanoma Or Adenocarcinoma
Published 2025 - 43rd Congress of the ESCRS
Reference: FP12.11 | Type: Free paper | DOI: 10.82333/7jmn-8412
Authors: Guy Kleinmann* 1 , Tomer Barnea 2 , Ehud Assia 3 , Elinor Megiddo Barnir 1
1Ophthalmology department,Sheba Medical Center,Ramat Gan,Israel, 2Faculty of Medical and Health Sciences,Tel Aviv University,Tel Aviv,Israel, 3Ein Tal Eye Center,Tel Aviv,Israel
Purpose
Cataract surgery following proton beam irradiation (PBI) for uveal melanoma or ciliary body adenocarcinoma can be a challenging procedure, even for experienced surgeons. Risk factors are the presence of limbal stem cell deficiency (LSCD), scleral ischemia, keratopathy, dry eye disease, anterior and/or posterior synechiae, zonular fragility and phacodonesis. This study describes the surgical planning and presents the outcomes and complications of cataract surgery in eye tumor patients who underwent PBI.
Setting
Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, FAA, Lausanne, Switzerland
Methods
Retrospective chart review of intraocular melanoma (n=45) and adenocarcinoma (n=2) patients irradiated (60 CGE in 4 fractions) at the Paul Scherrer Institute (Villigen, CH) between 1990 and 2024 and who subsequently underwent cataract surgery. The cataract surgery protocol privileged regional or general rather than topical anesthesia, clear corneal incisions avoiding the irradiated surface, staining the anterior lens capsule with trypan blue, a large capsulorhexis (≥ 6 mm) and the use of a hydrophobic intraocular implant, with its haptics placed perpendicular to the tumor apex. Some cases also required synechiolysis and/or iris hooks. The OPTIS2 irradiation plan permitted to locate the irradiated part of the eye, surrounding the tumor scar.
Results
The study included 47 patients (M/F ratio: 25/22). Mean age at the time of cataract surgery was 56.5 years (± 9.8). Mean time between PBI and surgery was 21 months (± 15). The mean percentages of the lens's center and periphery receiving at least 90% of the total irradiation dose were 39% (± 37) and 43% (± 33), respectively. Median preoperative BCVA was CF [LP - 0.8], and mean preoperative intraocular pressure (IOP) was 16 mmHg (± 5). No major complications were reported during surgery. Documented postoperative complications included secondary glaucoma (24%), significant inflammation (6%) and cystoid macular edema (4%). Median postoperative BCVA was 0.25 [NLP- 1.0], and mean postoperative IOP was 15 mmHg (± 6).
Conclusions
Eye tumor patients treated with PBI require careful preoperative planning and an adapted cataract surgery protocol to avoid complications. Appropriate follow-up allows to identify and treat potential postoperative ocular hypertension, inflammation and cystoid macular edema.