Deng X, Cheng Y, Zhu X M, Linghu D D, Zhao M W, Liang J H
Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing 100044, China.
Zhonghua Yan Ke Za Zhi. 2020 Sep 11;56(9):681-687. doi: 10.3760/cma.j.cn112142-20200318-00197.
To evaluate the potential association between optic nerve invasion and optic nerve obscuration during treatment of advanced retinoblastoma. Retrospective case series study. Medical records of 77 patients (77 eyes) with advanced retinoblastoma (Group D/E) who were treated with primary or secondary enucleation in the Ophthalmology Department of Peking University People's Hospital from January 1 2012 to December 31 2015 were retrospectively reviewed. RetCam photographs under general anesthesia at diagnosis and each subsequent follow-up were evaluated for complete obscuration of the optic nerve. The primary endpoints included prelaminar invasion, postlaminar invasion and optic nerve transection invasion. Group difference was calculated with chi-square. There were 46 boys and 31 girls in the study. The mean age at the first diagnosis was (27.1±22.1) months. The optic nerve was obscured in 62 eyes (80.5%) at the first diagnosis and 61 eyes (79.2%) at the last ocular examination prior to enucleation. Twenty-nine eyes (37.7%) underwent primary enucleation. Forty-eight eyes (62.3%) were treated with eye-preserving therapy, followed by enucleation. Fourteen eyes (18.2%) were in Group D and 63 eyes (81.8%) were in Group E. Histopathologic analysis of enucleated eyes without optic nerve obscuration (16 eyes) showed prelaminar invasion in 7 eyes, postlaminar invasion in 2 eyes and optic nerve transection invasion in 0 eyes. Histopathologic analysis of enucleated eyes with optic nerve obscuration (61 eyes) showed prelaminar invasion in 26 eyes, postlaminar invasion in 9 eyes and optic nerve transection invasion in 4 eyes. The difference between two groups did not achieve statistical significance (=0.935, 1.000, 0.296). Histopathologic analysis of enucleated eyes with persistent complete obscuration of the optic nerve showed a high risk factor in 10 eyes (10/40), while in 1 eye (1/8) the optic nerve was visible at the initial presentation and obscured before secondary enucleation (=0.529). Optic nerve obscuration at the last examination prior to enucleation may not be associated with postlaminar optic nerve invasion in advanced retinoblastoma. .
评估晚期视网膜母细胞瘤治疗过程中视神经侵犯与视神经遮盖之间的潜在关联。回顾性病例系列研究。对2012年1月1日至2015年12月31日在北京大学人民医院眼科接受一期或二期眼球摘除术的77例（77只眼）晚期视网膜母细胞瘤（D/E组）患者的病历进行回顾性分析。评估诊断时及随后每次随访时全身麻醉下的RetCam照片，以确定视神经是否完全被遮盖。主要终点包括筛板前侵犯、筛板后侵犯和视神经横断侵犯。采用卡方检验计算组间差异。研究中有46名男孩和31名女孩。首次诊断时的平均年龄为（27.1±22.1）个月。首次诊断时62只眼（80.5%）的视神经被遮盖，眼球摘除术前最后一次眼部检查时61只眼（79.2%）的视神经被遮盖。29只眼（37.7%）接受了一期眼球摘除术。48只眼（62.3%）接受了保眼治疗，随后进行了眼球摘除术。14只眼（18.2%）属于D组，63只眼（81.8%）属于E组。对视神经未被遮盖的摘除眼球（16只眼）进行组织病理学分析，结果显示7只眼有筛板前侵犯，2只眼有筛板后侵犯，0只眼有视神经横断侵犯。对视神经被遮盖的摘除眼球（61只眼）进行组织病理学分析，结果显示26只眼有筛板前侵犯，9只眼有筛板后侵犯，4只眼有视神经横断侵犯。两组之间的差异无统计学意义（=0.935、1.000、0.296）。对视神经持续完全被遮盖的摘除眼球进行组织病理学分析，结果显示10只眼（10/40）存在高危因素，而1只眼（1/8）在初次就诊时视神经可见，在二期眼球摘除术前被遮盖（=0.529）。眼球摘除术前最后一次检查时视神经被遮盖可能与晚期视网膜母细胞瘤的筛板后视神经侵犯无关。
