Using data from consecutive retinoblastoma cases, researchers at the London Retinoblastoma Service found that patients with salvaged group D eyes have a high likelihood of poor visual acuity and strabismus after treatment.
Study design
This was a retrospective chart review of 32 Group D retinoblastoma eyes from 27 patients. All patients received first-line intravenous chemotherapy (IVC) and had at least 1 year of follow- up after their last treatment.
In addition to receiving IVC, most eyes underwent at least 1 adjuvant treatment, including intra-arterial chemotherapy (16%), plaque brachytherapy (16%), transpupillary thermotherapy (TTT, 56%) and cryotherapy (75%).
Investigators evaluated risk factors for final visual acuity, rate of strabismus, and nystagmus.
Outcomes
By their final visits, at a mean of 50.7 months after final treatment, 7 patients (26%) had 1 eye removed. Of the remaining 20, some type of strabismus was present in 15 (75%). Six of 27 (22%) had nystagmus. Final VA was worse than 20/200 in 16 eyes (50%); however, 7 (22%) had VA of 20/40 or better.
Multivariate analysis revealed that undergoing TTT was the only significant variable associated with risk of VA worse than 20/200.
Limitations
This was a retrospective study with a small number of patients (n=32).
Clinical significance
This study provides quantitative information regarding visual prognosis. With globe salvage rates improving in the last decade due to adoption of first-line intra-arterial chemotherapy, these results help clinicians to better guide patient expectations pertaining to the high likelihood of decreased vision and eye deviations.