Retinoblastoma surgery: Difference between revisions
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*[[Anterior chamber]] invasion | *[[Anterior chamber]] invasion | ||
Potential complications of enucleation include scleral perforation with seeding of [[tumor]] cells into the orbit. | Potential complications of enucleation include scleral perforation with seeding of [[tumor]] cells into the orbit. | ||
Adjuvant systemic [[chemotherapy]] or [[brachytherapy]] may be considered in patients with high-risk features to prevent metastatic disease (eg, [[ciliary body]], [[iris]], massive scleral | Adjuvant systemic [[chemotherapy]] or [[brachytherapy]] may be considered in patients with high-risk features to prevent metastatic disease (eg, [[ciliary body]], [[iris]], massive scleral or choroidal infiltration, and invasion of the [[optic nerve]] posterior to the lamina cribrosa). Adjuvant chemotherapy may reduce the development of contralateral or intracranial [[tumors]] ([[PNET]]) in children with a germline [[mutation]]. When there is a positive optic nerve margin or extrascleral/trans-scleral extension, [[external beam radiotherapy]] should be considered.<ref name="pmid12096963">{{cite journal| author=Honavar SG, Singh AD, Shields CL, Meadows AT, Demirci H, Cater J et al.| title=Postenucleation adjuvant therapy in high-risk retinoblastoma. | journal=Arch Ophthalmol | year= 2002 | volume= 120 | issue= 7 | pages= 923-31 | pmid=12096963 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12096963 }} </ref> Although somewhat controversial, adjuvant chemotherapy may reduce the development of contralateral or intracranial tumors (PNET) in the child with a germline mutation. <ref name="pmid22084213">{{cite journal| author=Kaliki S, Shields CL, Shah SU, Eagle RC, Shields JA, Leahey A| title=Postenucleation adjuvant chemotherapy with vincristine, etoposide, and carboplatin for the treatment of high-risk retinoblastoma. | journal=Arch Ophthalmol | year= 2011 | volume= 129 | issue= 11 | pages= 1422-7 | pmid=22084213 | doi=10.1001/archophthalmol.2011.289 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22084213 }} </ref> An orbital implant (typically [[hydroxyapatite]] or porous polyethylene) is placed at the time of enucleation. After Approximately after six weeks when the conjunctiva has healed, a prosthesis can be fitted by an ocularist. | ||
==References== | ==References== | ||
Revision as of 20:24, 16 October 2015
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Retinoblastoma surgery On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
Overview
The feasibility of surgery depends on the tumor size, tumor location, and presence or absence of vitreous or subretinal seeds at diagnosis. When the retinoblastoma is too large to be treated by other treatment modalities, surgery may be used. In these situations, enucleation may help to prevent metastasis.
Surgery
Enucleation is indicated for:
- Group E tumor
- Advanced group D tumors may require enucleation, particularly in the setting of unilateral disease
- Poor visual potential and have failed previous "globe-conserving" approaches
- Secondary glaucoma
- Poor view to the fundus with presumed active tumor
- Anterior chamber invasion
Potential complications of enucleation include scleral perforation with seeding of tumor cells into the orbit. Adjuvant systemic chemotherapy or brachytherapy may be considered in patients with high-risk features to prevent metastatic disease (eg, ciliary body, iris, massive scleral or choroidal infiltration, and invasion of the optic nerve posterior to the lamina cribrosa). Adjuvant chemotherapy may reduce the development of contralateral or intracranial tumors (PNET) in children with a germline mutation. When there is a positive optic nerve margin or extrascleral/trans-scleral extension, external beam radiotherapy should be considered.[1] Although somewhat controversial, adjuvant chemotherapy may reduce the development of contralateral or intracranial tumors (PNET) in the child with a germline mutation. [2] An orbital implant (typically hydroxyapatite or porous polyethylene) is placed at the time of enucleation. After Approximately after six weeks when the conjunctiva has healed, a prosthesis can be fitted by an ocularist.
References
- ↑ Honavar SG, Singh AD, Shields CL, Meadows AT, Demirci H, Cater J; et al. (2002). "Postenucleation adjuvant therapy in high-risk retinoblastoma". Arch Ophthalmol. 120 (7): 923–31. PMID 12096963.
- ↑ Kaliki S, Shields CL, Shah SU, Eagle RC, Shields JA, Leahey A (2011). "Postenucleation adjuvant chemotherapy with vincristine, etoposide, and carboplatin for the treatment of high-risk retinoblastoma". Arch Ophthalmol. 129 (11): 1422–7. doi:10.1001/archophthalmol.2011.289. PMID 22084213.