Fabian Ido D, Stacey Andrew W, Naeem Zishan, Onadim Zerrin, Chowdhury Tanzina, Duncan Catriona, Sagoo Mandeep S, Reddy M Ashwin
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; Department of Ophthalmology, University of Washington, Seattle, Washington.
J AAPOS. 2018 Aug;22(4):276.e1-276.e7. doi: 10.1016/j.jaapos.2018.03.007. Epub 2018 Aug 1.
To report the long-term strabismus rate in salvaged retinoblastoma (Rb) patients and investigate possible risk factors leading to strabismus.
The medical records of patients with Rb presenting at a single institution over a 9-year period were reviewed retrospectively with regard to ocular alignment outcomes after long-term follow-up.
A total of 64 eyes of 42 patients (22 bilateral cases [52%]) were included, presenting with International Intraocular Retinoblastoma Classification (IIRC) in the worse eye as follows: group A (n = 1), B (n = 16), C (n = 12), D (n = 11), no Rb (n = 2). Fifteen patients (36%) were initially referred because of family history of Rb. Mean age at presentation was 8.2 months (range, 0.3-58.3 months). Overall treatments included intravenous chemotherapy (62 eyes), intraophthalmic artery chemotherapy (10 eyes), brachytherapy (11 eyes), transpupillary thermotherapy (22 eyes), cryotherapy (47 eyes), and external beam radiotherapy (4 eyes). At final follow-up (mean, 93.7 months), 69% of patients had strabismus, with exotropia being the most common type (n = 18), followed by esotropia (n = 8), and alternate exotropia/esotropia (n = 3). On univariate analysis, the worse eye group IIRC and cTNMH, sporadic cases, strabismus, and foveal tumor at presentation were found to be significantly associated with strabismus at final follow-up (P ≤ 0.043). On multivariate analysis, only foveal involvement was found to be significant (P < 0.001).
Strabismus, exotropia in particular, is a common adverse sequela following successful conservative treatment for Rb, with 69% of the present cohort having some type of deviation after long-term follow-up, for which foveal tumor at presentation was found to be a significant risk factor.
报告挽救性视网膜母细胞瘤（Rb）患者的长期斜视发生率，并调查导致斜视的可能危险因素。
回顾性分析在单一机构就诊的Rb患者9年期间的病历，以了解长期随访后的眼位情况。
共纳入42例患者的64只眼（22例双侧病例[52%]），患眼国际眼内视网膜母细胞瘤分类（IIRC）情况如下：A组（n = 1）、B组（n = 16）、C组（n = 12）、D组（n = 11）、无Rb（n = 2）。15例患者（36%）最初因Rb家族史就诊。就诊时的平均年龄为8.2个月（范围0.3 - 58.3个月）。总体治疗方法包括静脉化疗（62只眼）、眼动脉化疗（10只眼）、近距离放疗（11只眼）、经瞳孔温热疗法（22只眼）、冷冻疗法（47只眼）和外照射放疗（4只眼）。在最终随访时（平均93.7个月），69%的患者存在斜视，外斜视是最常见类型（n = 18），其次是内斜视（n = 8）和交替性外斜视/内斜视（n = 3）。单因素分析发现，就诊时患眼IIRC分组、cTNMH、散发病例、斜视和黄斑部肿瘤与最终随访时的斜视显著相关（P≤0.043）。多因素分析显示，仅黄斑部受累具有显著意义（P < 0.001）。
斜视，尤其是外斜视，是Rb成功保守治疗后的常见不良后遗症，本队列中69%的患者在长期随访后出现某种类型的眼位偏斜，其中就诊时黄斑部肿瘤是一个显著的危险因素。
