Madreperla S A, Hungerford J L, Cooling R J, Sullivan P, Gregor Z
Center for Vision Research, Department of Ophthalmology, Case Western Reserve University, Cleveland, Ohio, USA.
Retina. 2000;20(1):28-32. doi: 10.1097/00006982-200001000-00005.
To analyze the results of vitreous surgery for late retinal detachment (RD) after successful treatment of retinoblastoma.
The records of all patients with retinoblastoma seen at a single ocular oncology service between 1982 and 1998 were reviewed to identify patients treated for late RD. Previous treatments, characteristics of the RD, surgical techniques used, and visual and anatomic results of the surgery were recorded.
Of more than 500 charts reviewed, four patients treated for late RD were identified. All four had received previous, whole-eye, external beam radiotherapy and subsequently required cataract surgery. Other previous treatments included radioactive plaque, cryotherapy, xenon photocoagulation, and chemotherapy. At presentation, some patients had shifting subretinal fluid. None had a tear identifiable preoperatively, but two patients had a definite small slit tear at a tumor edge identified at surgery. One patient had a primary scleral buckle that failed. All patients had vitreous surgery with silicone oil. Average postsurgical follow-up was 30 months. Preoperative visual acuity ranged from 20/80 to light perception and improved postoperatively in two patients. The retina remained completely attached in three patients.
Despite shifting subretinal fluid and no identifiable tear, a rhegmatogenous RD should be considered if it occurs late in patients with otherwise stable, treated retinoblastoma. Tumor reactivation must be excluded carefully. Vitreous surgery can be used to repair the RD successfully and improve vision.
分析视网膜母细胞瘤成功治疗后晚期视网膜脱离（RD）的玻璃体手术结果。
回顾1982年至1998年间在单一眼科肿瘤服务机构就诊的所有视网膜母细胞瘤患者的记录，以确定接受晚期RD治疗的患者。记录先前的治疗、RD的特征、所采用的手术技术以及手术的视觉和解剖结果。
在审查的500多份病历中，确定了4例接受晚期RD治疗的患者。所有4例患者均曾接受过全眼球外照射放疗，随后需要进行白内障手术。其他先前的治疗包括放射性敷贴、冷冻疗法、氙光凝和化疗。就诊时，一些患者有视网膜下液移动。术前均未发现裂孔，但2例患者在手术中发现肿瘤边缘有明确的小裂孔。1例患者原发性巩膜扣带术失败。所有患者均接受了硅油玻璃体手术。术后平均随访30个月。术前视力范围为20/80至光感，2例患者术后视力有所改善。3例患者视网膜保持完全附着。
尽管存在视网膜下液移动且未发现裂孔，但在原本病情稳定的视网膜母细胞瘤治疗后晚期发生的孔源性RD仍应予以考虑。必须仔细排除肿瘤复发。玻璃体手术可成功修复RD并改善视力。
