Desjardins L, Chefchaouni M Charif, Lumbroso L, Levy C, Asselain B, Bours D, Dendale R, Estève M, Michon J, Doz F
Institut Curie, 26, rue d'Ulm, 75005 Paris.
J Fr Ophtalmol. 2005 Sep;28(7):725-31. doi: 10.1016/s0181-5512(05)80984-2.
Because of long-term complications of external beam radiation in retinoblastoma, a new therapeutic modality using chemotherapy and local treatments is used whenever possible. We conducted a retrospective study to evaluate visual results.
We studied visual acuity and ocular side effects in children presenting uni- or bilateral retinoblastoma in whom we were able to achieve conservative management without external beam treatment. The treatments that were used included chemotherapy, chemothermotherapy, diode laser, iodine 125 plaque brachytherapy, and cryotherapy. The initial characteristics (diameter, subretinal or vitreous seeding, and location) of each tumor, the treatments used, their results, and the visual function after age 4 years were recorded.
We treated 429 children for retinoblastoma at the Curie Institute between October 1994 and December 2002. Two hundred twenty-seven eyes had conservative treatment without external beam. We were able to study the visual function in 102 eyes at a median age of 67 months. The median follow-up after the end of the treatment was 5 years. The mean visual acuity was 20/37 and 60% of the children had visual acuity of more than 20/40. Macular alteration was observed in 34 eyes. Statistical analysis showed that a larger tumor diameter of the retinal surface (p<0.0003) and location close to the macula (p<0.0001) were the most significant risk factors for vision loss.
The visual results of the treatment of retinoblastoma by chemotherapy and local treatments is good when the tumors are not located close to the macula. Larger tumors also have a worse prognosis for vision.
由于视网膜母细胞瘤外照射放疗存在长期并发症，因此尽可能采用化疗和局部治疗的新治疗模式。我们进行了一项回顾性研究以评估视觉效果。
我们研究了患有单侧或双侧视网膜母细胞瘤且能够在不进行外照射治疗的情况下实现保守治疗的儿童的视力和眼部副作用。所采用的治疗方法包括化疗、化疗热疗、二极管激光、碘125斑块近距离放疗和冷冻疗法。记录每个肿瘤的初始特征（直径、视网膜下或玻璃体播散以及位置）、所采用的治疗方法、治疗结果以及4岁后的视觉功能。
1994年10月至2002年12月期间，我们在居里研究所为429名视网膜母细胞瘤患儿进行了治疗。227只眼接受了不进行外照射的保守治疗。我们能够在中位年龄为67个月时研究102只眼的视觉功能。治疗结束后的中位随访时间为5年。平均视力为20/37，60%的儿童视力超过20/40。在34只眼中观察到黄斑改变。统计分析表明，视网膜表面肿瘤直径较大（p<0.0003）和靠近黄斑的位置（p<0.0001）是视力丧失的最显著危险因素。
当肿瘤不靠近黄斑时，化疗和局部治疗视网膜母细胞瘤的视觉效果良好。较大的肿瘤视力预后也较差。
