Nishida Koichi, Morimoto Takeshi, Suzuki Shigenobu, Iwahashi Chiharu, Imai Hisanori, Kuniyoshi Kazuki, Kusaka Shunji
Department of Ophthalmology, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan.
Department of Advanced Visual Neuroscience, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan.
Am J Ophthalmol Case Rep. 2022 Feb 2;25:101367. doi: 10.1016/j.ajoc.2022.101367. eCollection 2022 Mar.
To report the outcomes of two only seeing eyes of two cases with retinoblastoma in which vitrectomy was performed to treat vitreous hemorrhage or rhegmatogenous retinal detachment after treatment for retinoblastoma.
Case 1 was an 8-month-old girl whose bilateral retinoblastoma (group D, OU) was treated by chemotherapy and focal ablation therapy. As the tumor size increased, enucleation was required in the right eye. At 4 years of age, about 1 year after the last treatment for retinoblastoma, lens-sparing vitrectomy was performed for dense, nonclearing vitreous hemorrhage, which had occurred 6 months previously. No recurrence of the tumor was found, and the patient's visual acuity improved to 0.9 postoperatively. Case 2 was a 4-month-old boy who was diagnosed with bilateral retinoblastoma (group D, OD; group C, OS) and underwent treatment, including systemic and local chemotherapy and proton beam therapy. Because large, regressed tumor masses were present in the posterior pole of the right eye, the left eye was the only seeing eye. At the age of 1 year 7 months, retinal detachment developed in the left eye 1 month after cryotherapy was performed for tumor recurrence. Although a scleral buckling procedure without drainage was performed, the retina was not reattached. The retina was reattached after vitrectomy with melphalan irrigation and silicone oil tamponade. However, recurrence was noted 6 months after the operation, and enucleation was required.
Vitrectomy appears to be beneficial for the treatment of vision-threatening complications after retinoblastoma treatment. However, vitrectomy may be associated with the potential spread of tumor cells and/or tumor recurrence and therefore should be reserved as the last treatment modality for only seeing eyes. Careful postoperative follow-up is mandatory.
报告两例视网膜母细胞瘤患者仅存的一只眼中行玻璃体切除术治疗视网膜母细胞瘤治疗后玻璃体出血或孔源性视网膜脱离的结果。
病例1为一名8个月大的女孩，其双眼视网膜母细胞瘤（D组，双眼）接受了化疗和局部消融治疗。随着肿瘤体积增大，右眼需要行眼球摘除术。4岁时，即视网膜母细胞瘤最后一次治疗约1年后，因6个月前出现的致密、不吸收的玻璃体出血行保留晶状体的玻璃体切除术。未发现肿瘤复发，患者术后视力提高到0.9。病例2为一名4个月大的男孩，被诊断为双眼视网膜母细胞瘤（右眼D组；左眼C组），接受了包括全身和局部化疗以及质子束治疗。由于右眼后极部存在大的退缩性肿瘤块，左眼是仅存的有视力的眼。1岁7个月时，左眼在因肿瘤复发行冷冻治疗1个月后发生视网膜脱离。尽管进行了无引流的巩膜扣带术，但视网膜未复位。在玻璃体切除并灌注美法仑及硅油填塞后视网膜复位。然而，术后6个月出现复发，需要行眼球摘除术。
玻璃体切除术似乎有利于治疗视网膜母细胞瘤治疗后威胁视力的并发症。然而，玻璃体切除术可能与肿瘤细胞的潜在播散和/或肿瘤复发有关，因此应留作仅存的有视力的眼的最后治疗方式。术后必须进行仔细的随访。
