Tumor-Associated Cataract

Cataracts are opaque areas in the lens, which should be entirely clear. Cataracts can be secondary to age as well as mechanical, chemical, or radiation trauma. They are the single largest cause of blindness in the world accounting for over 47% of blindness worldwide. Intraocular tumors are a rare but important cause of cataract, and the presence of intraocular tumor as an underlying cause should be excluded when the cataract is unilateral, total, sectoral, or posterior subcapsular without an obvious cause such as trauma, inflammation, or steroid use. The cataract may be caused by the tumor itself or by previous interventions to diagnose (biopsy) or treat (steroids, excision, radiation, chemotherapy) the intraocular tumor. In the case of a poor view on funduscopy, the clinician must rely on thorough examination techniques and ancillary tests such as ultrasonography and ultrasound biomicroscopy to determine the presence and extent of an intraocular tumor. It is important to remember that the management of patients with intraocular tumors is complex, sometimes controversial, and in some instances, the tumor may have been treated with unfamiliar techniques. In this chapter we will discuss the various treatment-related causes of cataract, specific tumor entities associated with cataract, and special considerations for the management of cataract in patients with intraocular tumors

Non-ocular Tumors and Other Long-Term Complications

In the United States and other developed nations, more patients with retinoblastoma will die from non-ocular second malignant neoplasms than from their primary intraocular tumor. There is an increased lifetime risk of the development of second malignant neoplasms in survivors of heritable retinoblastoma compared with their nonheritable counterparts. Radiation increases the risk of second malignant neoplasms and should be avoided when possible. All patients at risk must be educated to remain vigilant for future signs or symptoms of malignancies and counseled to avoid exposure to other mutagens. The prognosis for patients with second malignant neoplasms is guarded and underscores the importance of counseling patients with the heritable form of the disease