Fabian Ido D, Naeem Zishan, Stacey Andrew W, Chowdhury Tanzina, Duncan Catriona, Reddy M Ashwin, Sagoo Mandeep S
Moorfields Eye Hospital, London, United Kingdom; Retinoblastoma Service, Royal London Hospital, London, United Kingdom; Ocular Oncology Service, Goldschleger Eye Institute, Sheba Medical Center, Tel-Aviv University, Tel Aviv, Israel.
Retinoblastoma Service, Royal London Hospital, London, United Kingdom.
Am J Ophthalmol. 2017 Jul;179:137-144. doi: 10.1016/j.ajo.2017.05.003. Epub 2017 May 10.
To analyze the long-term visual acuity, strabismus, and nystagmus outcomes in Group D retinoblastoma following multimodality treatments in a national retinoblastoma referral center.
Retrospective interventional case series.
A 13-year retrospective chart review of Group D eyes treated initially with intravenous chemotherapy (IVC) and followed up for at least 1 year from last treatment. Risk factors for final visual acuity (VA) were analyzed, and rate of strabismus and nystagmus at last follow-up visit were calculated.
One hundred and four Group D eyes (92 patients) presented to our center during the study period, of which 32 (27 patients) met the inclusion criteria. Following IVC (vincristine, etoposide, and carboplatin), adjuvant treatments included intraophthalmic artery chemotherapy in 5 (16%) eyes, plaque brachytherapy in 5 (16%), transpupillary thermotherapy (TTT) in 18 (56%), and cryotherapy in 24 (75%) eyes. On last examination, 64.41 ± 6.76 months from presentation, mean final VA was 20/283 (logMAR equivalent of 1.15 ± 0.15). On univariate analysis, presentation age, foveal retinoblastoma (at initial examination), use of TTT, and tumor-foveola distance (at last visit) were found to be significant risk factors for worse VA (P < .026). On multivariate analysis, however, only TTT was found to be significant (P = .010). At last visit, 6 of 27 (22%) patients had nystagmus and 12 of 20 (60%) bilaterally salvaged patients had strabismus (n = 10 exotropia and n = 2 esotropia).
After multimodality treatments initiated with IVC, 50% of salvaged Group D retinoblastoma eyes had <20/200 vision, with TTT being a risk factor for worse vision; 60% had strabismus; and 22% had nystagmus.
在一家全国性视网膜母细胞瘤转诊中心，分析D组视网膜母细胞瘤经多模式治疗后的长期视力、斜视和眼球震颤结局。
回顾性干预病例系列研究。
对最初接受静脉化疗（IVC）治疗的D组患眼进行为期13年的回顾性病历审查，并从最后一次治疗起随访至少1年。分析最终视力（VA）的危险因素，并计算最后一次随访时的斜视和眼球震颤发生率。
在研究期间，104只D组患眼（92例患者）到我们中心就诊，其中32只（27例患者）符合纳入标准。IVC（长春新碱、依托泊苷和顺铂）治疗后，辅助治疗包括5只眼（16%）接受眼内动脉化疗，5只眼（16%）接受敷贴近距离放疗，18只眼（56%）接受经瞳孔温热疗法（TTT），24只眼（75%）接受冷冻疗法。在最后一次检查时，距就诊平均64.41±6.76个月，平均最终视力为20/283（logMAR相当于1.15±0.15）。单因素分析发现，就诊年龄、黄斑部视网膜母细胞瘤（初诊时）、TTT的使用以及肿瘤-黄斑中心凹距离（最后一次就诊时）是视力较差的显著危险因素（P<.026）。然而，多因素分析显示，只有TTT具有显著性（P = .010）。在最后一次就诊时，27例患者中有6例（22%）有眼球震颤，20例双侧挽救性治疗的患者中有12例（60%）有斜视（外斜视10例，内斜视2例）。
采用IVC启动多模式治疗后，50%的挽救性D组视网膜母细胞瘤患眼视力<20/200，TTT是视力较差的危险因素；60%有斜视；22%有眼球震颤。
