Optic Nerve Obscuration in Retinoblastoma: A Risk Factor for Optic Nerve Invasion

Abstract

Background: The objective of this study is to evaluate the risk of optic nerve invasion associated with optic nerve obscuration at diagnosis or persisting during treatment. Methods: Retrospective review from 2011-2016 of patients with advanced retinoblastoma (Group D/E) with complete obscuration of the nerve at diagnosis and a second group of patients with persistent, complete obscuration throughout treatment. Results: Advanced retinoblastoma was diagnosed in 102 eyes of 86 patients. The optic nerve was obscured in 69 eyes (68%) at diagnosis. Of these, 30 (43%) underwent salvage therapy and 39 (57%) primary enucleation. Histopathologic analysis of primarily enucleated eyes showed 41% prelaminar and 15% postlaminar invasion. Four eyes in the salvage group demonstrated persistent nerve obscuration; 2 were subsequently enucleated without evidence of nerve invasion. Average follow-up was 23.5 months (range 1-62 months). Conclusions and Relevance: Optic nerve obscuration at diagnosis may be associated with postlaminar optic nerve invasion. While persistent, complete obscuration of the optic nerve by retinoblastoma during treatment is a poor prognostic sign for both globe salvage and vision, it does not appear, in this small cohort, to increase the risk of optic nerve invasion. With appropriate control of the intraocular tumor, these eyes can be salvaged.

Combined association of massive choroidal and optic nerve invasion as a prognostic relevance in primary retinoblastoma: A 10‐year study

“…Studies have shown that cases with massive choroidal invasion are more likely to develop metastasis 21 . Similar to our study, Berry et al too reported that optic nerve (RL+CE) invasion has the highest prediction ability for metastasis and mortality rate 22 . Our observation is similar to the study of Mendoza and coworkers in which they found statistically significant correlation between optic nerve (RL+CE) invasion and metastasis 23 …”

Clinicopathological Findings of Retinoblastoma: A 10-Year Experience from a Tertiary Hospital in Kampala, Uganda

“…Much higher cases with optic nerve invasion of 33.2% and 69.7% have been reported by Mukhtar and coworkers [25] in Uganda and Owoeye et al [23] in Nigeria, respectively. Optic nerve invasion appears to predict metastasis and mortality rate especially when the extent of invasion is considered [34]. Optic nerve involvement is found in 25%–45%; however, its risk on outcome appears to be limited to the involvement beyond the lamina cribrosa and to the optic nerve surgical margin [34].…”

“…Optic nerve invasion appears to predict metastasis and mortality rate especially when the extent of invasion is considered [34]. Optic nerve involvement is found in 25%–45%; however, its risk on outcome appears to be limited to the involvement beyond the lamina cribrosa and to the optic nerve surgical margin [34]. When the extent of optic nerve invasion was not considered and association with metastasis was done in this study, it was found that there was no association with metastasis ( P = 0.39) although the trend of cases with optic nerve invasion to develop metastasis was higher than the ones without optic nerve invasion.…”

Anatomo-Clinical Aspects of Retinoblastoma: A Series of 144 Cases

“…The Choroidal invasion has also been shown to correlate with molecular prognostic markers such as TP53, in contrast to other high-risk factors. Optic nerve invasion appears to predict metastasis and mortality, especially when the extent of invasion is taken into account [ 2 , 21 ]. Optic nerve involvement in our series was found in 27.9%; a rate similar to the 25% reported by Chebbi et al.…”