Changes of ocular lens and fundus in patient after exposure to 192Ir at"5.7"accident in Nanjing

Objective To make a summary of radiation-induced changes in ocular lens and retinal lesions based on dynamic follow-up of a patient exposed to a radiation exposure from 192Ir source accident, in order to provide the information and experience for the clinical diagnosis and treatment of such injury in emergency of a nuclear or radiation accident. Methods The examination methods included eye lens and visual acuity, slit-lamp examination, fundus examination, automated perimetry, optical coherence tomography (OCT) examination, fundus photography, and fundus fluorescein angiography (FFA). The patient was followed-up for 20 months. Comparative analyses were made of the follow-up results. Results One month after 192Ir radiation exposure, the visual acuities in both eyes were 1.0. Mild age-related opacities were observed in peripheral cortex, but the fundus looked normal. Twenty months later, the patient was followed-up. The visual acuities reduced to about 0.6, evident powder- and punctuate-like opacities could be observed in the cortex of the right lens, and mild turbid foci in the posterior polar and capsule. Multiple scotomata appeared in the superior temporal and inferior nasal in the right eye. The macular fovea thickness was not changed significantly in the right eye. Examination with fundus photography demonstrated mild optical nerve atrophy, drusens, and pale optic discs, while FFA examination showed punctuate or flocculent leakages in both eyes. Conclusions The lens opacity could be induced or accelerated by radiation exposure. In addition to the posterior capsule and pole cataracts, punctuate opacity within cortical layer may also occur. It also suggests that cataract and fundus injuries may occur later during long-term follow-up, even though the eyes may look normal during early examination after the patient exposed to the radiation. Key words: 192Ir; Bone marrow from of acute radiation sickness; Ocular lens; Fundus; Medical follow-up