Vitreoretinal complications of retinoblastoma treatment.
OBJECTIVE
To describe complications of the retina and vitreous occurring in children undergoing treatment for retinoblastoma and their clinical management.


METHODS
Retrospective analysis of Ret-Cam images of 206 patients with retinoblastoma treated at one center between 1996 and 2003. Images were studied for vitreoretinal features other than tumor persistence or recurrence. Specifically, complications such as vitreous, retinal, or choroidal hemorrhage, retinal detachment, retinal fold, vascular obstruction, and preretinal or subretinal proliferation were sought.


RESULTS
Vitreoretinal complications of retinoblastoma therapy were identified in 14 patients (6.8%) All had heritable bilateral retinoblastoma. Group 5 Reese-Ellsworth disease was present in 50% (n = 7). All patients had systemic chemotherapy, 50% had external beam radiotherapy, and 64% had more than one local treatment method. Of the 14 patients with a complication, 4 eyes were enucleated for massive recurrence of tumor, 5 eyes were observed, and 5 eyes were treated successfully with vitreoretinal surgery for tractional or rhegmatogenous retinal detachment.


CONCLUSIONS
Vitreoretinal complications occurred in 6.8% of patients undergoing therapy for retinoblastoma. These included retinal tears, rhegmatogenous and tractional retinal detachment, subretinal fibrosis, vitreous traction bands, preretinal fibrosis, and pseudo-vitreous seeding. They were more often seen when systemic chemotherapy was combined with external beam radiation, cryotherapy, and local chemotherapy.
Tawansy
Khaled A
KA
Children's Retina Institute of California, Glendale, CA 91205, USA. ktawansy@sbcglobal.net
Samuel
Michael A
MA
Shammas
Maya
M
Murphree
A Linn
AL
D000970:Antineoplastic Agents / Q000009:adverse effects*; D001918:Brachytherapy / Q000009:adverse effects; D002675:Child, Preschool; D002832:Choroid Hemorrhage / Q000209:etiology* / Q000473:pathology; D017679:Cryotherapy / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D017075:Laser Coagulation / Q000009:adverse effects*; D008297:Male; D009887:Ophthalmoscopy; D011379:Prognosis; D012163:Retinal Detachment / Q000209:etiology* / Q000473:pathology; D019572:Retinal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D012175:Retinoblastoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D014823:Vitreous Hemorrhage / Q000209:etiology* / Q000473:pathology
D000970:Antineoplastic Agents