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postoperative pressure rises after intraocular lens surgery.was repeated 4 hours after the first one to control theJ Cataract Refract Surg 1993; 19:62–63IOP. The effect of a single paracentesis to control ele-

9. Helbig H, Noske W, Kleineidam M, et al. Bacterial en-vated IOP, especially in the context of a postoperative dophthalmitis after anterior chamber paracentesis [letter].pressure spike, is well established.8

Br J Ophthalmol 1995; 79:866We report on a side-port paracentesis to relieve the

early CBDS. To our knowledge, this is the first timethis has been reported. Although we encountered nocomplications with the side-port paracentesis procedure Management of Radiotherapy-Inducedin our patients, endophthalmitis has been reported after Cataracts in Eyes with Retinoblastomaparacentesis9; strict adherence to sterile technique is

Eye-saving treatments such as radiotherapy and che-recommended. The advantage of a side-port paracente-motherapy are often used in early retinoblastomasis is that no additional anterior or posterior Nd:YAG

and as a palliative measure in the later stages.1–3 Whichevercapsulotomy is required. It may be difficult to performradiotherapy method is used, cataract may be inducedNd:YAG capsulotomy because of corneal edema, nondi-in the affected eye and the fellow nonretinoblastoma eye.lation of the pupil, or too much posterior bowing ofIn the past 10 years, we have encountered 14 eyes withthe posterior capsule. In phacoemulsification, the sideradiotherapy-induced cataract, including 5 nonretino-port made at surgery is already present and controlledblastoma fellow eyes in 10 children with a mean age ofrelease of aqueous humor is possible under the slitlamp.6.3 years. Radiotherapy was administered to all patients

ARUN K. JAIN, MD with a total dose of 4500 to 6000 cGy in 19 to 25 sessionsJASPREET SUKHIJA, MS over 4 to 6 weeks depending on the stage and extent

JAGJIT S. SAINI, MDof the tumor. In eyes with radiotherapy-treated retino-Chandigarh, Indiablastoma, a minimum tumor inactivity period of 1 year

References was observed before cataract surgery.1. Holtz SJ. Postoperative capsular bag distension. J Cataract Detailed ocular and physical examinations of each

Refract Surg 1992; 18:310–317 patient were done before cataract surgery was performed2. Davison JA. Capsular bag distension after endophaco- under general anesthesia. Surgery was performed in

emulsification and posterior chamber intraocular lens im- 10 eyes, along with lens aspiration and posterior capsuleplantation. J Cataract Refract Surg 1990; 16:99–108

polishing. Primary posterior capsulorhexis was not per-3. Sorenson AL, Holladay JT, Kim T, et al. Ultrasonographicformed. The procedures were uneventful, and the integ-measurement of induced myopia associated with capsularrity of the posterior capsule was maintained in all eyes.bag distension syndrome. Ophthalmology 2000; 107:902–

At a postoperative follow-up ranging from 2.0 to9084. Tsuboi S, Tsujioka M, Kusube T, Kojima S. Effect of con- 3.7 years, the visual acuity was 6/24 to 6/12 in the

tinuous circular capsulorhexis and intraocular lens fixation nonretinoblastoma eyes after lens aspiration. Post-radio-on the blood-aqueous barrier. Arch Ophthalmol 1992; 110: therapy dry eye developed in 1 of the fellow eyes. How-1124–1127

ever, no significant intraoperative or postoperative5. Miyake K, Ota I, Ichihashi S, et al. New classification of

problems occurred, and the child regained a best cor-capsular block syndrome. J Cataract Refract Surg 1998;rected visual acuity of 6/12.24:1230–1234

In the tumor eyes with post-radiotherapy cataract,6. Kohnen T, von Her M, Shutt E, Koch DD. Evaluationof intraocular pressure with Healon and Healon GV in lens aspiration did not significantly improve visual acu-sutureless cataract surgery with foldable lens implantation. ity. However, an acceptably good cosmetic result wasJ Cataract Refract Surg 1996; 22:227–237 achieved without complications.

7. Sugiura T, Miyauchi S, Eguchi S, et al. Analysis of liquid The final visual improvement in these eyes de-accumulated in the distended capsular bag in early postop-

pended on the posterior polar and macular involvementerative capsular block syndrome. J Cataract Refract Surgof the tumor, radiation-induced keratopathy, maculopa-2000; 26:420–425thy, and optic neuropathy. Amblyopia is another signifi-8. John M, Souchek J, Noblitt RL, et al. Sideport incision

paracentesis versus antiglaucoma medication to control cant factor in visual acuity that does not improve after

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cataract surgery in this age group. During surgery, care racts treated for retinoblastoma and can give good visualresults in fellow eyes.was taken not to break the posterior capsule and disturb

the vitreous face. RAJESH SINHA, MD, FRCSUnlike cataract surgery of other pediatric cataracts, JEEWAN S. TITIYAL, MD

NAMRATA SHARMA, MDprimary posterior capsulorhexis and anterior vitrectomyRASIK B. VAJPAYEE, MBBS, MS

were not performed as the vitreous might contain retino- New Delhi, Indiablastoma seedlings that could disseminate. For the same

Referencesreason, a lensectomy by pars plana route was not used.1. Shields JA, Shields CL, Sivalingam V. Decreasing fre-

Reports have documented the spread of retinoblastoma quency of enucleation in patients with retinoblastoma.through the sclerotomy wound of the pars plana in- Am J Ophthalmol 1989; 108:185–188

2. Schipper J, Tan KEWP, van Peperzeel HA. Treatmentcision.4

of retinoblastoma by precision megavoltage radiation ther-We avoided intraocular lenses, although the postop- apy. Radiother Oncol 1985; 3:117–132

erative reaction was not high and was nearly the same 3. Abramson DH, Ellsworth RM, Tretter P, et al. Simultane-ous bilateral radiation for advanced bilateral retinoblas-as with other pediatric cataracts. Visual rehabilitationtoma. Arch Ophthalmol 1981; 99:1763–1766was achieved with the use of glasses or contact lenses.

4. Brooks HL Jr, Meyer D, Shields JA, et al. Removal ofThis limited series suggests that lens aspiration can radiation-induced cataracts in patients treated for retino-

blastoma. Arch Ophthalmol 1990; 108:1701–1708be safely performed in eyes with radiation-induced cata-

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