Management of retinal detachment in retinoblastoma with globe conserving treatment

Abstract

Purpose To investigate the features and outcomes of retinoblastoma (Rb) patients complicated by development of retinal detachment (RD) following systemic chemotherapy with or without local focal consolidation treatment and without external beam radiotherapy (EBRT). Methods A retrospective study of all Rb patients between April 2002 and April 2012 at a tertiary hospital center (Birmingham Children’s Hospital and Birmingham Midlands Eye Centre, United Kingdom). All eyes that had developed RD during or after systemic treatment with or without local focal consolidation treatment were included in the study. The time interval between the type of treatment of Rb, development of RD and relevant surgical intervention were analyzed. Patients with exudative RD were treated conservatively through observation and patients with rhegmatogenous RD were treated with scleral buckling. Final anatomical retinal reattachment rate and visual acuity outcomes were analyzed. Results A total of 258 patients were treated for Rb over the 10-year period. One hundred sixty-nine patients were managed with globe conserving treatment. Ten (5.92%) eyes of 10 patients were complicated with RD. Five eyes were exudative or presumed exudative type of RD while the other five eyes were rhegmatogenous or presumed rhegmatogenous RD. In the exudative group, two patients achieved visual acuity (VA) of 0.2 Single Kays (20/32 Snellen), and the other two patients achieved 0.85 and 0.86 Crowded Kays (20/142 and 20/145 Snellen), respectively, after the RD had resolved. The last patient in the group had to be enucleated due to tumor recurrences. The median time for the exudative RD to resolve is 15 weeks (range, 4–36 weeks). In the rhegmatogenous group, 3 of the 4 operated patients achieved retinal reattachment. The final postoperative VA ranged between 0.05 Crowded Kays to 1.84 Crowded Kays (20/22 to 20/1384 Snellen). The other patient was treated conservatively as no retinal breaks were found with previous cryotherapy and thermotherapy. The final VA in this patient was hand movement, and the RD did not reattach. The median time for the rhegmatogenous RD to reattach is 6 weeks (range, 4–8 weeks). There were no intra- and postoperative complications. Conclusions With long-term conservative management through observation, exudative Rb after systemic treatment of Rb will tend to resolve by itself. However, supplementary local treatment with cryoretinopexy or laser photocoagulation during the systemic treatment of Rb can lead to an increased risk of rhegmatogenous RD. In these cases, most rhegmatogenous RD are successfully repaired with non-drainage scleral buckling and cryoretinopexy.

Retinoblastoma Associated With Total Exudative Retinal Detachment

“…4 In a study of 258 patients with RB undergoing intravenous chemotherapy, exudative or rhegmatogenous RD was reported in 10 eyes (4%) while on globe-conserving treatment. 10 RD while on treatment is speculated to be due to rapid tumor regression resulting in retinal breaks or vitreoretinal traction. In our study, RD was present at the initial presentation, and 72% cases displayed RD resolution during chemotherapy.…”

Persistent Retinal Detachment in Retinoblastoma: The Challenges

“…Even though systemic chemotherapy is believed to help resolve an exudative RD, in one study, it might have caused the appearance of an exudative RD right after the first cycle of systemic chemotherapy. This was thought to be the result of excessive initial inflammation from the chemoreduction or of rapid shrinkage of the tumor [ 3 ].…”

“…Also, IAC has been shown to resolve 43% of total RD and 100% of partial RD related RB [ 4 ]. On the other hand, cases of exudative RD have been described after IAC, and the RD did not resolve despite the regression of the tumor [ 3 ]. One of those cases was a mixed tractional exudative RD after IAC [ 5 ].…”

Long-Term Results after Intraocular Surgery in Treated Retinoblastoma Eyes

“…Although EBRT has been largely abandoned, comparable complications are also found after brachytherapy with episcleral plaques [3]. Modern therapeutic approaches such as local and systemic chemotherapy in combination with cryotherapy or laser therapy may cause severe complications like vascular occlusion, vitreous hemorrhage, vascular proliferation, or retinal detachment [4, 5]. In a review by Pekacka [6], vitreous hemorrhage and vascular complications after intra-arterial chemotherapy (IAC) were reported with a frequency of 8% each.…”