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At least 955 records · Page 53Linked to original sources
PubMed2006

Treatment of retinoblastoma patients with chemoreduction plus local therapy: experience of the AC Camargo Hospital, Brazil.

To evaluate the efficacy of conservative management of intraocular retinoblastoma with chemoreduction combined with local therapy with or without plaque radiation in the preservation of the eye, and avoidance of external beam radiation therapy (EBRT) (success rate). From 1995 to 2000, 84 newly diagnosed patients with intraocular retinoblastoma were admitted to the Pediatric Department of the Hospital do Cancer A.C. Camargo, São Paulo, Brazil. All children were treated with 2 to 6 cycles of chemotherapy (carboplatin, vincristine, and etoposide) plus local therapy (cryotherapy, laser photocoagulation, and thermotherapy), or plaque radiation therapy during and/or after the chemotherapy. The Mann-Whitney test was used to compare means of quantitative variables. The chi test or the Fisher exact test were employed to verify the association between the outcome and the independent variables. For all tests alpha=5% was adopted. Success rate was higher for patients with bilateral tumors (54%) than for children with unilateral tumors (19%) (P=0.003). For patients with Reese-Ellsworth stages I, II, and III, no statistically significant differences in the success rates were noted in the group of unilateral (50%) and bilateral tumors (79.1%) (P=0.179). Among children with Reese-Ellsworth stages IV and V, the success rate was significantly higher for patients with bilateral tumors (40.7%) than for those with unilateral (0%) (P=0.012). Chemoreduction combined with local therapy, with or without plaque radiotherapy, is efficacious in avoiding enucleation and the use of external beam radiation therapy for children with intraocular retinoblastoma.

Adolescent↗
PubMed2006

Combined local treatment and chemotherapy in the management of bilateral retinoblastomas in Hungary.

This retrospective study supports that brachytherapy combined with cytostatic therapy may effectively contribute to tumor control. The second eye of 13 patients with bilateral retinoblastoma was treated with plaque brachytherapy after the enucleation of the first eye. Eleven patients received systemic cytostatic therapy. The mean follow up was 60 (+/-42 SD) months. Twelve patients are alive and free of tumor, 8 of them with acceptable visual acuity. After cytostatic therapy, late nephropathy was observed in 2 patients. In conclusion, brachytherapy combined with cytostatic therapy will be an option in the management of bilateral retinoblastoma after the enucleation of the first eye.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2002

Current treatment of retinoblastoma.

Chemotherapy has recently achieved a major role in the primary management of intraocular retinoblastoma. Tumor reduction by first-line chemotherapy (chemoreduction) followed by local treatments is now accepted as treatment strategy for intraocular retinoblastoma with the goal of avoiding external beam radiotherapy (EBRT) or enucleation. Although efficient in reducing tumor volume, chemotherapy cannot cure retinoblastoma. Different chemoreduction protocols are used to shrink the tumor, making it treatable with cryotherapy, laser photocoagulation, thermotherapy, and plaque radiotherapy. Systemic chemotherapy used with local ophthalmic therapies during or after the chemotherapy can eliminate the need for enucleation or external beam radiotherapy in Reese-Ellsworth group 1, 2, or 3 retinoblastoma. This combination is not sufficient to obtain tumor control in most eyes with large tumors and diffuse vitreous and subretinal seeds (Reese-Ellsworth group 4 and 5 tumors), and EBRT or enucleation is eventually required. The resultant visual acuity after globe-conserving therapies in those eyes with Reese-Ellsworth group 4 and 5 tumors is often poor. Preliminary results of a phase I/II study of subconjunctival carboplatin injection are encouraging. Enucleation is still recommended in situations such as eyes containing large tumors, long standing retinal detachment, neovascular glaucoma, pars plana tumor seeding, anterior chamber involvement or choroid, optic nerve or orbital tumor extension, and no expectation for useful vision. Chemoprophylaxis is necessary for patients with tumor extending to the surgical margin of the optic nerve and is likely beneficial in preventing metastases in patients with tumor extending beyond the lamina cribrosa. Intensified chemotherapy with autologous stem cell rescue appears effective for patients with metastatic retinoblastoma.

Brachytherapy↗
PubMed2003

Emerging strategies for the treatment of retinoblastoma.

PURPOSE OF REVIEW: Over the past 10 years, the treatment of retinoblastoma has changed dramatically. The main impetus for these changes, which are more intensive than traditional modalities and require a multidisciplinary approach, has been the avoidance of the serious, often fatal, complications of external beam radiation. The use of potent, well known chemotherapy agents in a novel setting (ie, intraocular tumor) has been successful in treating all but the most advanced disease. RECENT FINDINGS: This review will examine recent published work with chemotherapy and local (focal laser) treatment for intraocular (curable) retinoblastoma. Specifically, the concepts behind and the practice of chemoreduction and thermochemotherapy and their efficacies will be evaluated. SUMMARY: The work discussed herein constitutes an extremely nascent and dynamic field of work in ocular oncology. Much uncertainty remains, especially as most of these patients will live for many decades after their presentation and treatment. The review will show that a significant number of treatment failures still occur and that continued work is needed before we can feel confident treating young patients with all forms of this rare tumor.

Humans↗
PubMed2006

Vitreoretinal complications of retinoblastoma treatment.

PURPOSE: To describe complications of the retina and vitreous occurring in children undergoing treatment for retinoblastoma and their clinical management. METHODS: Retrospective analysis of Ret-Cam images of 206 patients with retinoblastoma treated at one center between 1996 and 2003. Images were studied for vitreoretinal features other than tumor persistence or recurrence. Specifically, complications such as vitreous, retinal, or choroidal hemorrhage, retinal detachment, retinal fold, vascular obstruction, and preretinal or subretinal proliferation were sought. RESULTS: Vitreoretinal complications of retinoblastoma therapy were identified in 14 patients (6.8%) All had heritable bilateral retinoblastoma. Group 5 Reese-Ellsworth disease was present in 50% (n = 7). All patients had systemic chemotherapy, 50% had external beam radiotherapy, and 64% had more than one local treatment method. Of the 14 patients with a complication, 4 eyes were enucleated for massive recurrence of tumor, 5 eyes were observed, and 5 eyes were treated successfully with vitreoretinal surgery for tractional or rhegmatogenous retinal detachment. CONCLUSION: Vitreoretinal complications occurred in 6.8% of patients undergoing therapy for retinoblastoma. These included retinal tears, rhegmatogenous and tractional retinal detachment, subretinal fibrosis, vitreous traction bands, preretinal fibrosis, and pseudo-vitreous seeding. They were more often seen when systemic chemotherapy was combined with external beam radiation, cryotherapy, and local chemotherapy.

Antineoplastic Agents↗
PubMed2006

Pars plana vitrectomy in eyes treated for retinoblastoma.

BACKGROUND: As conservative treatments for retinoblastoma become more prevalent, there will be a greater number of ocular complications developing in eyes that previously would have been enucleated. Pars plana vitrectomy (PPV) is needed to manage some of these complications. METHODS: The authors evaluated three consecutive cases of PPV in eyes that were successfully treated for retinoblastoma from the Retina Service of the Massachusetts Eye and Ear Infirmary (MEEI) performed between 1989 and 2004. A review of the literature to date regarding PPV after treatment for retinoblastoma was also performed. RESULTS: There was no tumor reactivation in the three cases at MEEI. Vision was maintained at light perception in one case, and there was improvement in vision from hand motions to 20/80 and 20/400 to 20/160 in two cases. Twelve of the 24 cases reviewed in the literature were found to have significant complications of recurrent tumor, need for enucleation, and/or systemic metastasis. CONCLUSION: PPV is associated with significant risks in eyes previously treated for retinoblastoma and should be reserved for monocular patients with no other alternative for retaining visual function. Areas that may influence outcome include different treatment modalities and length of time of documented tumor inactivity before PPV.

Adolescent↗
PubMed2006

Pathological optic-disc cupping.

PURPOSE OF REVIEW: Pathological optic-disc cupping is most often caused by glaucoma, but may be seen in many less-common neuro-ophthalmic conditions. The goal of this article is to examine a host of entities causing optic-disc cupping, present key differentiating characteristics and pathophysiologies, and outline diagnostic approaches. RECENT FINDINGS: Multiple entities not associated with elevated intraocular pressure or glaucomatous optic-nerve disease may result in pathologic optic-nerve excavation. Even with the photography and imaging of today, it is still difficult for the clinician to accurately diagnose other causes of optic-disc cupping. Up to 20% of patients may be misdiagnosed and treated for glaucoma due to misinterpretation of the optic-disc cupping. Newer forms of imaging including optical coherence tomography may assist the clinician in decision making. A scrutinizing history, close observation of disc appearance, and the vasculature will aid in the diagnosis of glaucoma or other entity of optic-disc cupping. SUMMARY: Optic-disc cupping is a consequence of myriad disorders. Knowledge of the anatomy and vasculature of the disc is quintessential to the understanding of how, why, when, and what type of optic-disc cupping occurs in various conditions. Cupping can be seen with neurological processes, including benign tumors, which are treatable. Patient history, visual fields assessment, and funduscopic findings are the key to unlocking the diagnosis of glaucomatous versus nonglaucomatous optic-disc cupping. As clinicians, we must remain vigilant and receptive to the findings of potentially ominous forms of nonglaucomatous optic-disc cupping.

Diagnosis, Differential↗
PubMed2006

Retinal nerve fiber layer analysis in the diagnosis of glaucoma.

PURPOSE OF REVIEW: The detection of optic disc and retinal nerve fiber layer damage and change is the cornerstone of glaucoma management. Assessment of the retinal nerve fiber layer for localized and diffuse damage has been traditionally based on clinical examination, with documentation of change primarily qualitative. With the latest improvements in optical imaging instruments, objective and quantitative measurements of the retinal nerve fiber layer are now possible. This review summarizes the results from recent cross-sectional studies evaluating the discriminating ability of automated retinal nerve fiber layer measurements to detect glaucoma, and from longitudinal studies assessing the ability to predict and monitor glaucomatous changes. RECENT FINDINGS: Numerous cross-sectional studies have documented good diagnostic accuracy of a scanning laser polarimeter (GDx VCC), the optical coherence tomograph (Stratus), and the Heidelberg Retina Tomograph retinal nerve fiber layer measurements for differentiating between healthy and glaucoma eyes. There are only limited data available on the ability of these retinal nerve fiber layer measurements to document change over time. SUMMARY: It is essential that the clinician understand the specific strengths and weaknesses of each technique so that only good quality retinal nerve fiber layer information will be used in conjunction with careful clinical examination and visual function testing for glaucoma management decisions. Longitudinal studies are needed to evaluate the ability of these instruments to document retinal nerve fiber layer change over time.

Diagnostic Imaging↗
PubMed2005

Exposure of orbital implants wrapped with polyester-urethane after enucleation for advanced retinoblastoma.

PURPOSE: Enucleation is the main form of treatment for advanced retinoblastoma. The major complication of this procedure is orbital implant exposure. Different implants and wrapping materials are currently in use. The aim of the current study was to analyze the complications associated with the use of polyester-urethane, an artificial dura substitute, as a wrapping material for enucleation in advanced retinoblastoma. METHODS: A retrospective review of 32 cases (28 patients), who were treated with enucleation for advanced retinoblastoma, was performed. The age of the patients ranged between 3 months and 6.7 years (median, 19 months). Additional chemotherapy was administered in 12 cases. The removed eyeball was replaced either with a silicone implant and polyester-urethane wrapping (13 cases) or hydroxyapatite, silicone-hydroxyapatite, or polyethylene implants without additional wrappings (19 cases). The follow-up period ranged from 7 months to 5.9 years (median, 22.4 months). Statistical analysis was performed using the Kaplan-Meier method. RESULTS: Single or multiple exposures occurred in 22% of cases (7/32). There were 6 exposures (46%, 6/13) in the group with polyester-urethane wrapping compared with only 1 exposure (5%, 1/19) in the implants without wrapping. This difference was statistically significant (p=0.0236). None of the other analyzed factors (additional chemotherapy, surgeon, age of the patient, or size of the implant) demonstrated a significant correlation to implant exposures. CONCLUSIONS: Wrapping of orbital implants with polyester-urethane resulted in a high rate of implant exposures after enucleation for advanced retinoblastoma. In this series, the best results were achieved with integrated implants without additional wrapping.

Child↗
PubMed2005

Free orbital fat graft to prevent porous polyethylene orbital implant exposure in patients with retinoblastoma.

PURPOSE: To determine if porous polyethylene orbital implant (Medpor) exposure can be prevented in retinoblastoma patients when the implant is placed in combination with a free orbital fat graft over the anterior surface of the implant. METHODS: Free orbital fat grafts were performed after enucleation and Medpor implantation, and results were compared with patients who underwent conventional enucleation and Medpor implantation without an orbital fat graft. RESULTS: Although implant exposure occurred in 13 of 39 eyes (33.3%) that had conventional enucleation and Medpor implantation, exposure did not develop in any of the 38 eyes that had the combined procedure with a free orbital fat graft. CONCLUSIONS: These findings suggest that a free orbital fat graft is a simple, effective way to prevent orbital implant exposure in patients requiring enucleation and Medpor implantation.

Adipose Tissue↗