• Ocular Pathology/Oncology, Pediatric Ophth/Strabismus, Retina/Vitreous

    Review of: Secondary Prevention of Retinoblastoma Revisited

    Soliman S, VandenHoven C, MacKeen L, et al. Ophthalmology, January 2020

    This paper describes OCT-guided localization and photocoagulation of invisible retinoblastoma tumors in pediatric patients.

    Study design

    This retrospective, noncomparative, single-institution, observational case series included 11 invisible posterior pole tumors in 5 children (7 eyes) with retinoblastoma. These lesions were not seen clinically but were detected via handheld OCT. Each lesion was localized using OCT calipers and flagged with a single laser burn. After the location was confirmed with OCT, the laser photocoagulation continued.

    Outcomes

    Localization and tumor-laser burn relationships were accurate in all 11 tumors. Two photocoagulation sessions were sufficient to manage 9 of the tumors, resulting in permanent flat scars. Within 3 months, 1 tumor developed OCT-detected subclinical recurrences and was treated by another laser session. The authors did not note gliosis, foveal involvement or retinal detachment at the 1-year follow-up. One tumor developed scar expansion and all scars showed pigmentary changes.

    Limitations

    This was a retrospective study but the results are very important because retinoblastoma is a rare disease. Imaging using OCT is a very good tool to detect preclinical tumors, however wide availability of handheld technology may be limited due to cost.

    Clinical significance

    This study shows that OCT screening and localization of preclinical retinoblastoma tumors is of utmost importance in patients with germline mutations. Precise laser localization can help limit the scar size.