Vitreoretinal Complications of Retinoblastoma Treatment

Tawansy, K.A.; Samuel, Michael; Shammas, Maya C.; Murphree, A. Linn

doi:10.1097/01.iae.0000225350.83931.f6

Cited by 26 publications

(32 citation statements)

References 13 publications

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“…Clinically detectable vitreoretinal complications are reported to occur in less than 10% of patients with retinoblastoma, but those complications appear to be more often seen when systemic chemotherapy is combined with external beam radiation, cryotherapy, and local chemotherapy. (11) In our series, all the eyes but one were enucleated for disease progression, but importantly, 92% of them had associated co-morbidities that influenced the decision to enucleate. The vitreoretinal complications of therapy cannot thus be underestimated as they likely influence the decision to enucleate.…”

Section: Discussionmentioning

confidence: 64%

Predictive factors of invasion in eyes with retinoblastoma enucleated after eye salvage treatments

Balaguer¹,

Wilson²,

Billups³

et al. 2009

Pediatric Blood & Cancer

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Background The impact of chemotherapy, focal therapies, radiation and co-existing ocular morbidities on histology of eyes with retinoblastoma enucleated following chemoreduction is not well known. Procedure 25 eyes (23 patients) with retinoblastoma enucleated after failing eye-salvage therapy were evaluated. Reasons for enucleation (tumor progression, subretinal or vitreous seeds) and co-morbid conditions (neovascular glaucoma, cataract, vitreous hemorrhage and retinal detachment) were documented. All specimens were reviewed for evidence of ciliary body, choroidal, optic nerve, and scleral invasion. Results The median age at diagnosis was 14 months (range, 1 to 37 months). Twenty eyes were classified as Reese-Ellsworth Group IV-V at diagnosis. Twenty-four eyes had recurrent disease at enucleation; one eye was enucleated for neovascular glaucoma and vitreous hemorrhage. Co-existing ocular morbidities at enucleation included vitreous hemorrhage (n=6), retinal detachment (n=9), neovascular glaucoma (n=9) and cataracts (n=3). Histologic findings included choroidal invasion (n=7), ciliary body invasion (n=4), optic nerve invasion (n=6) and scleral invasion (n=3). The median time from diagnosis to enucleation was 11 months. No treatment rendered prior to enucleation significantly increased the likelihood of invasion. However, co-existing retinal detachment and vitreous hemorrhage significantly increased the likelihood of optic nerve invasion (p=0.014 and p=0.011, respectively). Prolonged time to enucleation was significantly associated with the likelihood of choroidal (p=0.010) and ciliary body (p=0.021) invasion as well as invasion of multiple sites. Conclusion In eyes with retinoblastoma enucleated after chemoreduction, co-existing ocular morbidities and time to enucleation are predictive of extra-retinal extension.

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Section: Discussionmentioning

confidence: 64%

Predictive factors of invasion in eyes with retinoblastoma enucleated after eye salvage treatments

Balaguer¹,

Wilson²,

Billups³

et al. 2009

Pediatric Blood & Cancer

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“…for various clinical settings have not been standardized [4]. Tawansy et al [3] described numerous cases of patients treated with systemic chemotherapy and focal treatment (with laser) who then developed vitreoretinal complications. These complications included vitreous traction band, subretinal fibrosis, preretinal fibrosis, retinal detachment, and pseudo-vitreous seeding.…”

Section: Discussionmentioning

confidence: 99%

“…However, these therapies also have the potential for complications [3]. Laser treatment for retinoblastoma is widely accepted among ocular oncologists, either as a stand-alone therapy (usually for small tumors) or in combination with chemoreduction.…”

Section: Discussionmentioning

confidence: 99%

Orbital Recurrence following Aggressive Laser Treatment for Recurrent Retinoblastoma

et al. 2015

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Purpose: To report a case of a 29-month-old male with familial, bilateral retinoblastoma with orbital recurrence following aggressive laser treatment. Methods: This is a retrospective case report of a single patient. Results: A 3-week-old male was diagnosed with familial, bilateral retinoblastoma (group D OD, group A OS), and treated with 6 cycles of systemic chemotherapy and laser treatment. The patient exhibited full regression of tumors in both eyes. Two years after diagnosis, a small tumor recurrence within the macular laser scar of the right eye was discovered. The tumor recurrence was treated with argon and diode laser over 6 months. The tumor recurrence completely resolved following the laser treatments. Ten weeks after the last laser treatment, MRI revealed a large intraconal orbital mass, contiguous with the sclera of the right eye. Orbital biopsy and systemic work-up confirmed the diagnosis of retinoblastoma with no other metastatic foci. B-scan ultrasonography showed thinning of the sclera at the site of recurrence. Conclusion: This is an unusual orbital recurrence after successful treatment of intraocular disease with aggressive laser therapy. Clinicians should be aware of the rare possibility of orbital recurrence following chemoreduction with local consolidation even when fundus examinations are normal.

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“…Globe salvage has also been possible for many eyes since the advent of combined systemic chemotherapy and sequential thermal laser, or chemoreduction (CRD), in the mid 1990s 1–2 .With preservation of retinoblastoma eyes, more complications are being recognized, including vitreous, retinal, or choroidal hemorrhage, retinal vascular occlusion, epiretinal membrane formation, glial proliferation, retinal fold, retinal detachment, glaucoma, neovascularization, and cataracts 3–4 . In this series, we review the clinical and histological findings of 3 patients who developed severe proliferative vitreoretinopathy (PVR) after CRD for retinoblastoma.…”

mentioning

confidence: 99%

Proliferative Vitreoretinopathy in Treated Retinoblastoma

Hwang

Mendoza

Wells

et al. 2017

Ophthalmology Retina

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Objective To evaluate the clinical and histopathologic characteristics of patients who develop proliferative vitreoretinopathy after retinoblastoma treatment. Design Retrospective review of three cases of proliferative vitreoretinopathy (PVR) that developed after successful treatment of retinoblastoma from 2003 to 2015. Subjects Three patients with treated retinoblastoma who developed severe PVR and required enucleation. Methods Review of clinical charts, fundus drawings, Ret-Cam 3 images, and histopathology specimens. Main Outcome Measures Clinical and histopathologic characterization of PVR in treated retinoblastoma. Results Three patients developed severe PVR after sequential thermal laser combined with systemic chemotherapy for retinoblastoma. At presentation patients were 6, 7, and 9 months of age, and all had bilateral retinoblastoma. Time to development of proliferative tissue was 9, 12, and 20 months after initial treatment. Proliferation was characterized by progressive growth of white vascularized tissue with associated traction on the retina and sometimes hemorrhage. All patients underwent enucleation. Histopathologic evaluation revealed treated retinoblastoma tumor with a Type 3 regression pattern, pre- and subretinal fibrovascular tissue consistent with PVR, and reactive changes in the retinal pigment epithelium. None of the patients developed recurrence of retinoblastoma or systemic metastasis. Conclusion PVR uncommonly develops after successful treatment of retinoblastoma and may result in traction or rhegmatogenous retinal detachment along with vitreous hemorrhage. Early stages of proliferation may be difficult to distinguish from recurrent tumor. Enucleation may be required due to poor vision and inability to adequately monitor for tumor recurrence.

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Vitreoretinal Complications of Retinoblastoma Treatment

Cited by 26 publications

References 13 publications

Predictive factors of invasion in eyes with retinoblastoma enucleated after eye salvage treatments

Predictive factors of invasion in eyes with retinoblastoma enucleated after eye salvage treatments

Orbital Recurrence following Aggressive Laser Treatment for Recurrent Retinoblastoma

Proliferative Vitreoretinopathy in Treated Retinoblastoma

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