Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
Br J Ophthalmol. 2019 Jun;103(6):753-760. doi: 10.1136/bjophthalmol-2018-312125. Epub 2018 Jul 5.
BACKGROUND/AIMS: To assess tumour control, vision and anatomical visual potential in eyes with perifoveal retinoblastoma treated by sequential photocoagulation from the antifoveal tumour edge inwards, avoiding treatment near the fovea. Patients were monitored for tumour control, foveal and perifoveal anatomy at each treatment session by optical coherence tomography (OCT) and treated for amblyopia when the other eye had better vision.
Eyes with perifoveal retinoblastoma treated between 1 January 2011 and 31 May 2017 with laser therapy after chemotherapy for juxtafoveal (fovea clear of tumour but <3000 µm from tumour edge) or foveolar retinoblastoma (tumour underlying fovea) were retrospectively reviewed for tumour control without recurrence, anatomical success (foveal pit preservation and/or restoration with ≥500 µm perifoveal retina free of tumour and scar) and functional success (acceptable (>0.1 decimal) or good (>0.3 decimal) visual acuity (VA)).
Twenty-two eyes (14 juxtafoveal, 8 foveolar tumours) of 20 patients (19 bilateral, 1 familial and 11 females) were included. No juxtafoveal tumour had tumour recurrence, and 13/14 patients showed foveal pit preservation with ≥500 µm of perifoveal retina tumour free. Foveolar tumours had significant worse anatomical outcomes: failure to restore foveal pit or perifoveal retina (8/8, p=0.001) and tumour recurrences (5/8, p=0.001). Functional success with acceptable VA was achieved in 12/14 juxtafoveal and 5/8 foveal tumours eyes (p=0.01). Amblyopia therapy data were insufficient to evaluate impact on VA.
Anatomical visual potential and functional vision were better in juxtafoveal than foveolar retinoblastoma treated with foveal-sparing laser photocoagulation guided by OCT. The role of amblyopia therapy requires a prospective study.
背景/目的：评估经抗黄斑肿瘤边缘向黄斑内顺序光凝治疗周边部视网膜母细胞瘤的肿瘤控制、视力和解剖学视功能。通过光学相干断层扫描（OCT）在每次治疗时监测肿瘤控制、黄斑和周边部解剖情况，并在对侧眼视力较好时治疗弱视。
回顾性分析 2011 年 1 月至 2017 年 5 月期间接受化疗后接受激光治疗的周边部视网膜母细胞瘤（肿瘤距黄斑中心凹无肿瘤但<3000μm）或黄斑下视网膜母细胞瘤（肿瘤位于黄斑下）患者的肿瘤无复发、解剖成功（黄斑中心凹小凹保存和/或恢复，至少 500μm 周边部无肿瘤和瘢痕）和功能成功（可接受（>0.1 小数）或良好（>0.3 小数）视力）。
纳入 20 例患者（19 例双眼，1 例家族性，11 例女性）的 22 只眼（14 例黄斑旁，8 例黄斑下肿瘤）。14 例黄斑旁肿瘤无肿瘤复发，13/14 例患者至少保留 500μm 黄斑旁无肿瘤的视网膜小凹。黄斑下肿瘤解剖学结局较差：黄斑小凹未恢复或周边部视网膜（8/8，p=0.001）和肿瘤复发（5/8，p=0.001）。14 例黄斑旁肿瘤中有 12 例（p=0.01）可获得可接受的 VA，8 例黄斑下肿瘤中有 5 例（p=0.01）可获得可接受的 VA。弱视治疗数据不足以评估其对视功能的影响。
OCT 引导的黄斑旁视网膜母细胞瘤经保留黄斑的激光光凝治疗后，解剖学视功能和功能性视力优于黄斑下视网膜母细胞瘤。弱视治疗的作用需要前瞻性研究。
