Chojniak Martha Maria Motono, Chojniak Rubens, Testa Maria Luiza, Min Tjioe Tjia, Guimarães Marcos Duarte, Barbosa E Silva Andréa Maria, Antoneli Célia Beatriz Gianotti
Department of Ophthalmology, Universidade Santo Amaro, São Paulo, Brazil.
J Pediatr Hematol Oncol. 2012 Apr;34(3):e102-5. doi: 10.1097/MPH.0b013e318236c346.
Enucleation is typically performed for the treatment of advanced retinoblastoma in children. After enucleation, the orbit undergoes abnormal development. In this study, orbital asymmetry was calculated using computed tomography measurements obtained from patients who experienced enucleation for unilateral retinoblastoma. Influence factors analyzed included: type of treatment, use of orbital implants, and patient's age at diagnosis. A total of 42 children underwent enucleation with a mean follow-up period of 4.8 years. For 28 patients, treatment included enucleation alone, 14 patients received enucleation plus radiation therapy. Thirty patients kept orbital implants long term. The mean orbital volume asymmetry for treated versus contralateral orbits was 16.8%. Mean asymmetry in orbital volume was greater for patients who underwent enucleation combined to radiation therapy (23.7% vs. 13.3%, P=0.05) and for patients without long-term maintenance of the prosthetic implants (29.3% vs. 11.8%, P<0.01). In conclusion, orbital volume is abnormally affected in children after enucleation of 1 eye for the treatment of retinoblastoma, and computed tomography can precisely quantify the asymmetry that develops. Orbital implants improve volumetric growth after enucleation, with 2-fold greater orbital asymmetry achieved without an implant.
眼球摘除术通常用于治疗儿童晚期视网膜母细胞瘤。眼球摘除术后，眼眶会出现异常发育。在本研究中，通过对单侧视网膜母细胞瘤患者眼球摘除术后的计算机断层扫描测量结果来计算眼眶不对称性。分析的影响因素包括：治疗类型、眼眶植入物的使用以及诊断时患者的年龄。共有42名儿童接受了眼球摘除术，平均随访期为4.8年。28例患者仅接受了眼球摘除术，14例患者接受了眼球摘除术加放射治疗。30例患者长期保留眼眶植入物。治疗侧眼眶与对侧眼眶的平均眼眶容积不对称率为16.8%。接受眼球摘除术联合放射治疗的患者眼眶容积平均不对称率更高（23.7%对13.3%，P=0.05），未长期维持假体植入物的患者眼眶容积平均不对称率更高（29.3%对11.8%，P<0.01）。总之，为治疗视网膜母细胞瘤而摘除一只眼后，儿童的眼眶容积会受到异常影响，计算机断层扫描可以精确量化所出现的不对称性。眼眶植入物可改善眼球摘除术后的容积增长，未植入时眼眶不对称率会增加两倍。
