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Cataract after Brachytherapy of Intraocular Choroidal Melanoma

1Rastegar Z. N., 2Stefani F. H.,
1 (München)
2Ludwig-Maximilians-Universität, Klinikum Innenstadt, Augenklinik (München)

Purpose: Cataract is an important effect of exposure to ionizing radiation. In this study, patients with an intraocular choroidal melanoma whom an episcleral Ru-106 plaque had been implanted were examined in the years 1998/99. In all cases, only one eye was fully or partly exposed to the radiation. The maximum dose at the top of the tumor was 100 Gy. The minimum duration between explantation of the plaque and examination was one year. Aim of the study was to investigate whether there are statistically significant differences in the occurrence of lens opacities in the irradiated eyes relative to the non-irradiated eyes.
Methods: To analyze the lens opacities, a modified Topcon SL-45 B Scheimpflug camera system of the University of Munich has been used in this study. Three Scheimpflug images from three different meridian angles were obtained for each eye. The images were first analyzed quantitatively for opacities and then these results were analyzed statistically.
Results: Evaluation of Scheimpflug images distinguishes five anatomical lens regions: I. Anterior capsule, II. Anterior cortex, III. Nucleus, IV. Posterior cortex, V. Posterior capsule. The lenses of 31 patients have been examined. The degrees of opacities in the irradiated eyes were compared with the values for the non-irradiated eyes. The statistical analysis of the results indicated no significant increase of lens opacities in the irradiated eyes.
Conclusions: Subjective analyses of the images showed slight to strong opacities in regions IV and V in about 70% of the patients who had been irradiated before 1993. Also, almost 40% of the patients who had been irradiated after 1993 showed slight opacities. This apparent contradiction between the statistical results and the results of the subjective analyses may be explained by the fact that these opacities were located outside the visual axis and were thus not (or only partly) registered in the digital image analyses.