APR 11, 2013
This retrospective case series of patients with intraocular retinoblastoma treated with chemoreduction found that absence of foveolar involvement and greater number of tumors predicted long-term visual outcome of 6/12 or better.
The study included 96 new retinoblastoma patients (140 eyes). The authors reviewed their clinical records and used multivariate analysis to evaluate factors predictive of final visual acuity.
All patients were treated with six cycles of chemoreduction with vincristine, etoposide and carboplatin. Adjuvant therapy was given in the form of transpupillary thermotherapy (TTT) or cryotherapy after two to three cycles of chemoreduction when there was reduction in tumor height to 2 mm or less and basal diameter of 4 mm or less. I125 plaque therapy and external beam radiotherapy were reserved for recurrent and large tumors. In subfoveolar tumors during adjuvant treatment with TTT or cryotherapy, care was taken to spare the fovea.
Follow-up ranged from 2 to 14 years. Final mean logMAR was 0.79. Good vision of ≥ 6/12 was seen in 52 eyes (37 percent). Extrafoveolar tumor and greater number of tumors in the eye were the only predictors of visual acuity ≥ 20/40.
Greater number of tumors correlated with smaller mean basal tumor diameter, with the mean basal tumor diameter 9.8 mm in eyes with multiple tumors and 12.2 mm in eyes with single tumors (P = 0.03). The authors say that the fact that eyes with smaller tumors generally have less extensive retinal detachment could be a factor in the better visual outcomes achieved in these eyes.