97th DOG Annual Meeting 1999



J. Wachtlin, A. O. Schueler, N. E. Bechrakis, H. Helbig

Purpose: Investigation of the functional outcome, the rate of complications and the safety and efficacy of cataract operations following the treatment of malignant melanomas.

Methods: In a retrospective study we reviewed the records of 57 patients who underwent cataract operation after treatment for malignant melanoma of the eye (25 with a ruthenium plaque, 25 with a iodine125 plaque, 9 with tumor excision (5 of them with additional ruthenium plaque) and 3 with proton beam iradiation). The mean follow up period was 16,8 months.

Results: The mean interval between treatment and cataract operation was 17,9 months (1-46). A lens implantation was performed in 52 eyes (91%), in 46 eyes (86%) in the capsular bag and in 4 (7,6%) in the sulkus. The operation was complicated by posterior synechiae 22 (38,5%) the underlaying secondary glaucoma 18 (31,5%), and by rubeosis iridis 16 (28%). Iris retractors were used in 14 eyes (24,6%) and in 12 eyes (21%) a rupture of the posterior capsule occurred. The best postoperative visual acuity improved in 71,9 % (ruthenium 92%, iodine 60%, excision 88 %, proton beam 66%) by 2 or more lines, 24,56% (ruthenium 8%, iodine 36%, excision 11%, proton beam 33%) remained unchanged and 3,5% lost 2 or more lines. The last recorded visual acuity was in 42,1% (ruthenium 60%, iodine 24%, excision 55,5%, proton beam 33%) 2 or more lines better than prior to cataract extraction, in 38,6% (ruthenium 24%, iodine 52%, excision 33,3%, proton beam 33,3 %) unchanged, and in 19,29% (ruthenium 16%, iodine 24%, excision 11,1%, proton beam 33,3%) reduced by 2 or more lines. After cataract operation, it became obvious in 7 patients (12,28%) that there was need for additional radiation. 3 patients developed metastatic disease.

Conclusion: Cataract extraction leads directly postoperative and on the long run to a functional improvement in the majority of the patients. The operation is made more difficult by synechia secondary glaucoma and rubeosis iridis. The cataract extraction gives the advantage of better tumor follow-up and can reveal recurrence. There is no indication for a higher risk of metastasis.

Department of Ophthalmology, University-Clinic Benjamin Franklin, D - 12200 Berlin