After multimodality treatments initiated with IVC, 50% of salvaged Group D retinoblastoma eyes had <20/200 vision, with TTT being a risk factor for worse vision; 60% had strabismus; and 22% had nystagmus.
The proportion of visual and ocular motility complications may be reduced by providing age-adjusted doses of melphalan. Dose rather than complications from catheterisation is the most important risk factor for ocular injury.
BackgroundEarly diagnosis strategies and advances in retinoblastoma (Rb) management have resulted in nearly 100% survival. More attention should, therefore, be given to quality of life considerations. We aimed to quantify the number of examinations under anaesthesia (EUAs) in a cohort of patients with Rb, as a measure of disease burden.MethodsA retrospective analysis of patients with unilateral Rb that presented to the London Rb service from 2006 to 2013, were treated and had long-term follow-up. Correlations of clinical variables to number of EUAs were investigated.ResultsA total of 107 patients with Rb were included that presented at a mean age of 26.51 ± 22.68 months. The International Intraocular Retinoblastoma Classification (IIRC) was group B in 5 (5%), C in 13 (12%), D in 48 (45%) and E in 41 (38%) of the cases. Primary treatment was intravenous chemotherapy in 36 (34%) and enucleation in 71 (66%) of the cases. Mean number of EUAs was 20.67 ± 6.62, 12.52 ± 6.23 and 11.15 ± 6.91 for combined groups B/C, group D and group E patients (p < 0.001), respectively. On analysis, early age atpresentation and conservative treatments were found to significantly correlate with increased number of EUAs (p < 0.001). Mean follow-up time was 74.42 ± 25.16 months and no metastasis or death were reported.ConclusionFamilies should be counselled regarding the number of EUAs associated with the patient's IIRC group, with B/C eyes undergoing twice the number as compared with D/E eyes. For group D cases, where both enucleation and conservative therapy are valid options, treatment choice has a significant impact on the number of EUAs.
BackgroundAdjuvant use of laser with systemic chemotherapy for treatment of retinoblastoma may reduce recurrence rates while also causing local side effects. Information is lacking on the effect of laser on visual outcomes.MethodsA retrospective review of two retinoblastoma centres in the United Kingdom was conducted. Patients were included if there was a macular tumour in at least one eye. Eyes that received chemotherapy alone were compared with eyes that received chemotherapy plus adjuvant laser.ResultsA total of 76 patients and 91 eyes were included in the study. Systemic chemotherapy alone was used in 71 eyes while chemotherapy plus laser was used in 20 eyes. Demographic characteristics of both groups were similar. Macular relapse rates were similar between groups: 22/71 (31%) eyes in chemotherapy group and 9/20 (45%) eyes in laser group (p=0.29). There was no increase in vitreous relapses in the laser group (2/20 eyes), compared with the chemotherapy group 10/71 eyes (p=0.99). Survival analysis demonstrated similar time to first relapse between groups. Final visual acuity was equal between groups with 6/15 or better present in 31.1% of eyes in the chemotherapy group and 37.5% of eyes in the laser group (p=0.76). Presence of tumour at the fovea was predictive of final visual acuity, regardless of treatment group.ConclusionAdjuvant laser in the treatment of retinoblastoma is safe and does not lead to increased rate of vitreous recurrence. Final visual acuity is determined by the presence of tumour at the fovea and not the use of laser.
Aim: To identify the types and prevalence of visual problems in a small series of acute stroke patients and identify the effectiveness of the existing screening tool used by occupational therapists (OTs) at the Royal London Hospital. Strategies will be suggested for improving this screening process and for aiding rehabilitation. Methods: A prospective study is presented comprising a small series of patients referred to the acute stroke unit at the Royal London Hospital with a confirmed diagnosis of stroke. On admission to the ward, all patients underwent an OT screen for visual problems prior to a full orthoptic assessment that included visual fields to confrontation and assessment of visual inattention/neglect. This was performed without the benefit of the OT screen findings to prevent bias. A comparison was made between orthoptic and OT findings to determine the effectiveness of the existing screening tool. Results: Twenty-eight patients were recruited with a mean age of 67 years (range 39-89 years). Orthoptic assessment revealed reduced visual acuity (<0.300 logMAR) in 43% of patients, with most stroke survivors demonstrating good binocular function (94%) and a full range of ocular motility (57%). No patient had visual inattention and 7% were found to have visual field defects. In 68% of stroke survivors the findings of the OT and the orthoptist were comparable. Conclusions: The OT screening tool was found to be effective in this study. Ways to improve the detection of visual deficits in acute stroke patients are discussed.
The assessment of vision has a growing importance in the management of retinoblastoma in the era of globe-conserving therapy, both prior to and after treatment. As survival rates approach 98–99% and globe salvage rates reach ever-higher levels, it is important to provide families with information regarding the visual outcomes of different treatments. We present an overview of the role of vision in determining the treatment given and the impact of complications of treatment. We also discuss screening and treatment strategies that can be used to maximise vision.
Strabismus, exotropia in particular, is a common adverse sequela following successful conservative treatment for Rb, with 69% of the present cohort having some type of deviation after long-term follow-up, for which foveal tumor at presentation was found to be a significant risk factor.
Current practice in retinoblastoma (Rb) has transformed this malignancy into a curable disease. More attention should therefore be given to quality of life considerations, including measures related to examinations under anesthesia (EUAs). We aimed to investigate EUA measures in bilateral Rb patients, and compare the findings to EUAs in unilateral Rb. MethodsA retrospective analysis of bilateral Rb patients that presented to the London Rb service from 2006-2013, were treated and had long-term follow-up. ResultsA total of 62 Rb patients, 15 (24.2%) of which had International Intraocular Retinoblastoma Classification (IIRC) group A/B/no Rb at presentation, 26 (41.9%) C/D, and 21 (33.9%) were E in at least one eye. The mean number of EUAs was 35.8±21.5, mean time from first to last EUA was 50.6±19.9 months and mean EUA frequency was 0.715±0.293 EUAs/month. IIRC group was found not to correlate with any of the EUA measures. Age at presentation inversely correlated with time interval from first to last EUA and to EUA frequency (p≤0.029). Rb Family history correlated with the latter measure (p=0.005) and intra-ophthalmic artery chemotherapy and brachytherapy correlated with all EUA measures (p≤0.029). Mean follow-up time was 80.1±24.3 months. When compared to a previously reported cohort of unilateral Rb, the present group underwent 3x more EUAs (p<0.001) over nearly double the time (p<0.001). ConclusionsFamilies should be counselled on anticipated EUA burden associated with bilateral Rb. In this respect age at presentation and family history were found to have a predictive role, whereas IIRC group did not.
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