RMS is the most common paediatric soft tissue sarcoma and has an excellent prognosis with a survival rate of greater than 85%. PBRT is increasingly used to treat patients with orbital RMS, theoretically sparing normal tissues with fewer side-effects than conventional radioatherapy. Visually threatening complications from PBRT have been reported in adults, including cataracts and glaucoma. There is a lack of data on management of paediatric cataract and outcomes of paediatric cataract surgery following orbital PBRT. We report our experience and outcomes of cataract surgery in children treated with PBRT for orbital RMS.

A retrospective case series of all children seen at the Oxford Eye Hospital with a diagnosis of orbital RMS and who received PBRT. Pre- and intra-operative details, complications and visual outcomes were recorded for the period between September 2010 and February 2018.

4 patients received PBRT for orbital RMS, median age at diagnosis was 6 years (range:0.5-7). Median follow-up period was 3.5 years (range:1-7). 3 children required cataract surgery, median interval post-PBRT 2.5 years (range:2-2.5). Primary IOL insertion was performed in all cases: 2 in bag and 1 in sulcus. Two developed posterior capsular opacification at 8 and 10 months, successfully treated with YAG capsulotomy. Long-term VA for two patients was logMAR 0.00 and 0.325. The 3rd case required occlusion therapy post-surgery. No patients developed secondary glaucoma, retinopathy or neuropathy.

Cataract was a common complication in patients undergoing PBRT. The oculoplastic surgeon should consider cataract in any child with reduced vision after PBRT treatment.