Objective: To evaluate the safety and timing of cataract surgery in eyes with retinoblastoma according to the time of diagnosis, treatment, operation method, and operation result. Methods: We reviewed the medical records of 23 patients (25 eyes) who underwent cataract extraction at Beijing Children's Hospital,Beijing Tongren Hospital, and Quanzhou Children's Hospital for a secondary cataract that developed after retinoblastoma treatment. The subjects included 11 boys (11 eyes) and 12 girls (14 eyes). Seven eyes underwent transparent corneal incision with a 25G vitreous cutter, and 18 eyes underwent scleral micro-incision at the flat portion of the ciliary body with either a 25G or 27G vitreous cutter. Follow-up was carried out for 1-72 months, with an average of 24 ± 16 months. The aim of the follow-up was to measure time from cataract diagnosis to operation, to examine the number and types of preoperative treatments, and to observe whether or not there was tumor metastasis around the surgical incision. Results: The average age of the children who participated in the study was 35 ± 19 months (range, 14-72 months). The time (median) from retinoblastoma diagnosis to discovery of a cataract was 19 months, and the time lapse(median) between cataract discovery and cataract surgery was 5 months. The time (median) between the previous retinoblastoma treatment and cataract surgery was 10 months. Before cataract extraction, we carried out 102 systemic chemotherapies on 22 children, 62 local laser treatments on 12 eyes, 19 intravitreal injections on 11 eyes, one radiotherapy on one eye, 10 freezing treatments on 6 eyes, and performed 20 vitrectomies on 17 eyes. In two eyes, the fundus could not be seen during the treatment process. The fundus couldn't be seen in two patients, but there was a recurrence of the tumor by the B ultrasonic examination.The cataracts were surgically removed, and the tumors were postoperatively trented by local laser. There was no recurrence of the tumor in these two patients within the follow-up period. Twenty-three eyes were
operated on after tumor calcification, and 19 of those showed no recurrence within the follow-up period. Late tumor-related complications appeared in four eyes, including one that developed secondary glaucoma,two with hyphemas, and one with a recurrence of the intraocular tumor. In these cases, the eye had to be
enucleated. Pathologic examination revealed no metastasis associated with the cataract surgery incision.Conclusions: For children with retinoblastoma, cataract surgery was necessary to provide a clear field of vision for fundus examination, especially among children who needed to continue retinoblastoma treatment. Cataract surgery is safe when choosing an incision site on the cornea or the flat part of the ciliary body, which minimizes the complexity of the operation in eyes without tumor growth.