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Management of retinal detachment after first-line intra-arterial chemotherapy for advanced retinoblastoma

Session Details

Session Title: Vitreoretinal Surgery II

Session Date/Time: Friday 18/09/2015 | 08:00-10:00

Paper Time: 09:52

Venue: Calliope

First Author: : J.Pournaras SWITZERLAND

Co Author(s): :    J. Potic   M. Gaillard   T. Wolfensberger   M. Beck Popovic   F. Munier  

Abstract Details

PURPOSE:First line intra-arterial chemotherapy was proposed recently as a new conservative treatment for retinoblastoma patients. The aim of this retrospective study is to analyze the occurrence of rhegmatogenous retinal detachment in patients with advanced retinoblastoma treated with first line intra-arterial chemotherapy and their surgical outcome

Setting:

Retrospective case study

Methods:

Advanced retinoblastoma patients (n=30) treated with first line intra-arterial chemotherapy at the Jules-Gonin Eye Hospital (November 2008 to October 2014) were included. Indications for retinal detachment surgery were either new or persistent detachment. Scleral buckle surgery with anterior chamber ponction was performed without drainage of sub-retinal fluid

Results:

Of 30 patients (30 eyes), 3 cases had bilateral tumor. Classification was as following: Group C (n=1), Group D (n=23), Group D/E (n=2), Group E (n=4). Average age at the first intra-arterial injection was 28.7 months. Cumulative injected dose of Melphalan was 11.44 mg, with a mean number of 2.7 injections. Before treatment, 11 patients (34%) had retinal detachment at presentation, and 19 (63%) patients had none. After chemotherapy, 16/19 (84.2%) patients developed retinal detachment (1 localized, 6 subtotal, 9 total). All the 11 patients presenting retinal detachment at the first examination regressed spontaneously after treatment (100%). Mean time between the intra-arterial chemotherapy and beginning or worsening of retinal detachment was 41 days. Average observation period before surgery was 4.1 months. In 10 patients, scleral buckle was indicated, but only 9 underwent surgery. In 1 patient with shallow retinal detachment, it was decided to continue with clinical follow-up only. Regression of retinal detachment was seen in 8/9 cases (89%), with complete reapplication in 6/9 patients (67%). One patient showed no change (11%).

Conclusions:

First line intra-arterial chemotherapy for advanced retinoblastoma provides good tumor control, but in this series secondary retinal detachment occurred in 16/30 cases (50%). Retinal reapplication was obtained with scleral buckling in more than two thirds of patients. The early treatment of this complication is important for salvage of the globe and visual function

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