Mullaney P B, Karcioglu Z A, Huaman A M, al-Mesfer S
King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
Br J Ophthalmol. 1998 May;82(5):517-21. doi: 10.1136/bjo.82.5.517.
Preseptal and orbital cellulitis are rare presenting features of intraocular retinoblastoma. The objectives of this study were to determine the frequency of retinoblastoma associated cellulitis, as well as to review its clinical and histopathological features.
The medical records of 292 retinoblastoma patients in the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia were reviewed. Those indicating a history of, or presenting with, cellulitis were retrieved and their clinical, radiological, and histopathological variables were assessed. Patients with definite extraocular tumour extension on clinical or radiological examination were excluded.
14 patients were found to have retinoblastoma associated cellulitis (4.8%); nine had bilateral and five had unilateral retinoblastoma. Conjunctival and blood cultures were performed in 10 cases and were negative. 10 children were treated with intravenous steroids, often in conjunction with antibiotics, resulting in a prompt decrease in inflammation. Three other children were treated with antibiotics alone and one received no treatment. Computed tomographic scanning depicted large intraocular tumours occupying between 80% and 100% of the globe in each case. In eight patients, periocular inflammation was radiologically interpreted as possible extraocular extension. In one patient serial computed tomographic scanning showed a reduction in intraocular calcification over time which occurred in the presence of cellulitis, 12 patients underwent enucleation and histopathological examination revealed large necrotic, poorly differentiated tumours associated with uveal involvement and early optic nerve invasion. Focal perilimbal destruction was seen in one patient, and in another peripapillary extrascleral extension was present. 12 patients are alive with a mean follow up of 56.4 months.
Radiological evaluation of scleral integrity may be hindered by periocular inflammatory changes. The orbital cellulitis correlated well with the presence of advanced intraocular retinoblastoma with massive necrosis and anterior chamber involvement. In the majority of patients, cellulitis was not indicative of an extension of retinoblastoma into the orbit. Intravenous steroid treatment reduced orbital inflammation, facilitating examination and subsequent enucleation.
睑前蜂窝织炎和眼眶蜂窝织炎是眼内视网膜母细胞瘤罕见的表现特征。本研究的目的是确定视网膜母细胞瘤相关蜂窝织炎的发生率，并回顾其临床和组织病理学特征。
回顾了沙特阿拉伯利雅得国王哈立德眼科专科医院292例视网膜母细胞瘤患者的病历。检索出有蜂窝织炎病史或表现为蜂窝织炎的患者，并评估其临床、放射学和组织病理学变量。临床或放射学检查发现有明确眼外肿瘤扩展的患者被排除。
发现14例患者患有视网膜母细胞瘤相关蜂窝织炎（4.8%）；9例为双侧视网膜母细胞瘤，5例为单侧视网膜母细胞瘤。10例患者进行了结膜和血培养，结果均为阴性。10名儿童接受了静脉类固醇治疗，通常联合使用抗生素，炎症迅速减轻。另外3名儿童仅接受抗生素治疗，1名儿童未接受治疗。计算机断层扫描显示，每例患者眼内均有巨大肿瘤，占据眼球的80%至100%。8例患者的眼周炎症在放射学上被解释为可能的眼外扩展。1例患者的系列计算机断层扫描显示，在蜂窝织炎存在的情况下，眼内钙化随时间减少。12例患者接受了眼球摘除术，组织病理学检查显示为巨大坏死、低分化肿瘤，伴有葡萄膜受累和早期视神经侵犯。1例患者可见局限性角膜缘破坏，另1例患者可见视乳头周围巩膜外扩展。12例患者存活，平均随访56.4个月。
眼周炎症改变可能会妨碍对巩膜完整性的放射学评估。眼眶蜂窝织炎与晚期眼内视网膜母细胞瘤伴大量坏死和前房受累密切相关。在大多数患者中，蜂窝织炎并不表明视网膜母细胞瘤已扩展至眼眶。静脉类固醇治疗减轻了眼眶炎症，便于检查和随后的眼球摘除术。
