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Yousef YA, AlHabahbeh O, Mohammad M, Halalsheh H, Mehyar M, Toro MD, AlNawaiseh I. Optimizing Surgical Management for Rhegmatogenous Retinal Detachment in Eyes with Active Retinoblastoma: A Safety-Driven Approach. J Clin Med 2024; 13:2511. [PMID: 38731040 PMCID: PMC11084380 DOI: 10.3390/jcm13092511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/03/2024] [Accepted: 04/12/2024] [Indexed: 05/13/2024] Open
Abstract
Introduction: Intraocular surgeries are conventionally contraindicated for patients with active retinoblastoma (Rb) due to the potential risk of tumor dissemination. However, surgery is occasionally necessary to preserve vision in patients with a single eye when the eye is complicated by rhegmatogenous retinal detachment (RRD). Objective: This study aims to evaluate the outcomes of surgical repair for RRD in pediatric patients with active Rb utilizing a non-drainage scleral buckling approach. Results: This cohort included six eyes from six patients who harbored active Rb and presented with RRD; one had a concurrent tractional component. All eyes (100%) had active intraocular Rb and were undergoing active therapy (systemic chemotherapy, cryotherapy, and thermal laser therapy) when RRD developed. RRD consistently manifested at the site of recent cryotherapy in all cases. RRD repair in the affected eyes was performed by scleral buckling without subretinal fluid drainage. Five of the six eyes (83%) achieved complete retinal reattachment. One eye (17%) with a tractional component exhibited partial reattachment and was eventually enucleated due to persistent active disease. At a median follow-up of 15 months (range 12-180 months) after scleral buckling, all five eyes had persistent retinal attachment, and no case developed orbital or distant metastasis. Conclusions: Our study demonstrates that nondrainage scleral buckling is an effective and safe method for the surgical repair of RRD in eyes harboring active Rb, as most cases achieved persistent complete retinal reattachment without the risk of tumor spread.
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Affiliation(s)
- Yacoub A. Yousef
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman 11941, Jordan; (O.A.); (M.M.); (M.M.)
| | - Omar AlHabahbeh
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman 11941, Jordan; (O.A.); (M.M.); (M.M.)
| | - Mona Mohammad
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman 11941, Jordan; (O.A.); (M.M.); (M.M.)
| | - Hadeel Halalsheh
- Department of Pediatric Oncology, King Hussein Cancer Center, Amman 11941, Jordan;
| | - Mustafa Mehyar
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman 11941, Jordan; (O.A.); (M.M.); (M.M.)
| | - Mario Damiano Toro
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland;
- Eye Clinic, Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Ibrahim AlNawaiseh
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman 11941, Jordan; (O.A.); (M.M.); (M.M.)
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Rating P, Bornfeld N, Schlüter S, Westekemper H, Kiefer T, Stuschke M, Göricke S, Ketteler P, Ting S, Metz KA, Bechrakis NE, Biewald E. Long-Term Results after Intraocular Surgery in Treated Retinoblastoma Eyes. Ocul Oncol Pathol 2022; 8:161-167. [PMID: 36938377 PMCID: PMC10015588 DOI: 10.1159/000524610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/15/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction: The aim of the study was to analyze the results of intraocular surgery in treated retinoblastoma eyes and to assess the long-term results with a priority on local recurrences, secondary enucleation, and metastases. Methods: Retrospective noncomparative case series. Results: From March 1964 to January 2020, 42 eyes of 40 retinoblastoma patients underwent intraocular surgery. Time interval between the last therapy and surgery was 9.5 years (mean: 114 months; median: 54.5 months). 31 eyes were treated for radiogenic cataract formation with a gain in visual acuity of 61.3%. One child developed an upper eyelid metastasis, 3 showed second primary malignancies (SPM), one a late recurrence, and 2 eyes were enucleated. Retinal surgery was performed in 17 eyes; 6 eyes were done as a combined procedure. Indications were radiogenic complications in the sense of a vitreous hemorrhage in 11 eyes and a rhegmatogenous retinal detachment in 6 eyes. 41.2% of the treated eyes had a postoperative gain in visual acuity, whereas 9.5% of the eyes could not be preserved in the long term. Regarding systemic involvement 2 patients developed late recurrences and one a SPM. Conclusion: Surgical therapy in treated retinoblastoma is necessary in isolated cases. In our series, cataract surgery was a safe procedure with a good option of a significant increase in visual acuity. As expected, vitreoretinal treated eyes showed a limited gain in visual acuity, a higher risk of late recurrences, and a lower globe retention rate. Therefore, a careful indication and individual risk-benefit analysis are mandatory.
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Affiliation(s)
- Philipp Rating
- aDepartment of Ophthalmology, University Hospital Essen, University Duisburg-Essen, Duisburg, Germany
- *Eva Biewald,
| | - Norbert Bornfeld
- aDepartment of Ophthalmology, University Hospital Essen, University Duisburg-Essen, Duisburg, Germany
| | - Sabrina Schlüter
- aDepartment of Ophthalmology, University Hospital Essen, University Duisburg-Essen, Duisburg, Germany
| | - Henrike Westekemper
- aDepartment of Ophthalmology, University Hospital Essen, University Duisburg-Essen, Duisburg, Germany
| | - Tobias Kiefer
- aDepartment of Ophthalmology, University Hospital Essen, University Duisburg-Essen, Duisburg, Germany
| | - Martin Stuschke
- bDepartment of Radiation Oncology, University Hospital Essen, University Duisburg-Essen, Duisburg, Germany
| | - Sophia Göricke
- cDepartment of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Duisburg, Germany
| | - Petra Ketteler
- dDepartment of Paediatric Haematology and Oncology, University Duisburg-Essen, Duisburg, Germany
| | - Saskia Ting
- eInstitute of Pathology and Neuropathology, University Hospital Essen, University Duisburg-Essen, Duisburg, Germany
| | - Klaus A. Metz
- eInstitute of Pathology and Neuropathology, University Hospital Essen, University Duisburg-Essen, Duisburg, Germany
| | - Nikolaos E. Bechrakis
- aDepartment of Ophthalmology, University Hospital Essen, University Duisburg-Essen, Duisburg, Germany
| | - Eva Biewald
- aDepartment of Ophthalmology, University Hospital Essen, University Duisburg-Essen, Duisburg, Germany
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Lin SH, Xu YG, Zhao JH, Cui H, Jin H, Jia YJ, Zhao J, Li YJ. Choroidal metastasis with retinal detachment: A case report. Medicine (Baltimore) 2021; 100:e28009. [PMID: 34941041 PMCID: PMC8702016 DOI: 10.1097/md.0000000000028009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/11/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Breast carcinoma is the most common primary source of choroidal metastasis (CM). In the present case, esophageal cancer was the primary tumour, brain metastasis occurred, and CM occurred later in the left eye with 2 retinal detachments, which is very rare. PATIENT CONCERNS A 62-year-old man complained of a sudden decrease in visual acuity consisting of a small shadow in front of his left eye with a sensation of covered vision after 1 cycle of systemic chemotherapy and radiotherapy for resected esophageal cancer with brain metastasis. Fundus examination revealed exudative retinal detachment without retinal tears. CM with exudative retinal detachment was also considered. The patient refused further treatment. After the second cycle of chemotherapy, there were no significant changes in the retina and visual acuity improved. However, after craniocerebral surgery for brain metastasis, the visual acuity decreased again and showed 3 choroidal masses with macular involvement and retinal detachment but without retinal tears. DIAGNOSIS The final diagnosis was CM with retinal detachment. INTERVENTIONS The patient was advised to undergo enucleation of the left eye during the second retinal detachment, but he refused. OUTCOMES Two months after the second retinal detachment, the patient died of systemic metastases. LESSONS It is important to consider CM when the first retinal detachment and known cancer are diagnosed. At present, it is necessary to develop a standardised treatment plan as well as a multidisciplinary approach to early diagnosis, combined treatment, and timely intervention for such cases.
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Affiliation(s)
- Shu-Hua Lin
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji Jilin, China
| | - Yong-Gen Xu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Jing-Hua Zhao
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji Jilin, China
| | - Hong Cui
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji Jilin, China
| | - Hua Jin
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji Jilin, China
| | - Yu-Jie Jia
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji Jilin, China
| | - Jian Zhao
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji Jilin, China
| | - Ying-Jun Li
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji Jilin, China
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Wendt SP, Barrett DA, Chang EY, Schefler AC. Segmental Scleral Buckle Surgical Technique for Repair of a Rhegmatogenous Retinal Detachment in Retinoblastoma: A Case and Review of the Literature. Ocul Oncol Pathol 2020; 7:91-96. [PMID: 33981692 DOI: 10.1159/000508721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/15/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose The aim of this study was to describe the surgical repair of a rhegmatogenous retinal detachment (RRD) with a posterior break in a child with retinoblastoma (RB). Methods Retrospective case report and review of the English language literature. Retrospective review of an 11-month-old male with bilateral retinoblastoma who developed a RRD with a posterior retinal break in his better-seeing eye after treatment with cryotherapy. A review of all published cases to date of RRD in patients with RB is presented. Results The patient underwent a posterior segmental scleral buckle without subretinal fluid drainage with successful reattachment of the retina and no extraocular extension of RB. Conclusions RRDs in RB patients may be successfully repaired with anatomic success and no extraocular tumor extension. Even for patients with a posterior break, a segmental scleral buckle without drainage of subretinal fluid is a viable option and long-term excellent vision is a possible outcome.
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Affiliation(s)
| | - Dianne A Barrett
- Cizik Eye Clinic, University of Texas Health Science Center, Houston, Texas, USA
| | | | - Amy C Schefler
- Cizik Eye Clinic, University of Texas Health Science Center, Houston, Texas, USA.,Retina Consultants of Houston and Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA
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Persistent Retinal Detachment in Retinoblastoma: The Challenges. J Ophthalmol 2020; 2020:1486757. [PMID: 33005444 PMCID: PMC7508214 DOI: 10.1155/2020/1486757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 08/21/2020] [Accepted: 09/03/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Retinoblastoma (RB) is the most common eye tumor in children. There have been significant improvements in treatment options targeting killing the tumor while also conserving the eye and attempting to conserve functional vision. Retinal detachment (RD) is not an uncommon event and compromises the vision and sometimes RB treatment. Materials and Methods Retrospective review of 62 patients over a period of 8 years between 2012 and 2019 with eyes treated for RB and having persistent RD that did not resolve after complete tumor regression. Results Forty-two patients of these 62 cases developed RD (67%). The RD resolved in 35 patients (83% of RD), and 7 patients (16% of RD) developed a persistent RD. In all the persistent RD groups (7 patients/11 eyes), RB and RD were present simultaneously in the first ophthalmological assessment. Sex ratio was 2 females/5 males. The mean age of diagnosis was 11 months. All eyes had advanced RB stages. Eight eyes had local treatment with transpupillary laser, 6 eyes received IAC, and 3 patients received systemic chemotherapy. In 9 eyes, the RD had both exudative and tractional components. Only one eye had a pure tractional RD due to persistent fetal vasculature, and one eye had rhegmatogenous RD component with presence of a tear in addition to exudation. None of the eyes received RD surgical repair. Conclusion Persistent RD occurs in eyes with advanced RB stages with complex RD with more than one component. The dilemma is performing a vitrectomy in eyes with cancer and poor visual outcome.
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Rishi P, Sharma U, Sharma T. Cavitary retinoblastoma: clinical observations. Eye (Lond) 2020; 34:704-710. [PMID: 31534184 PMCID: PMC7093433 DOI: 10.1038/s41433-019-0581-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/29/2019] [Accepted: 08/13/2019] [Indexed: 11/09/2022] Open
Abstract
AIM A retrospective case series describing the clinical features and treatment outcomes in eye with cavitary retinoblastoma. METHODS Case records of patients diagnosed with cavitary retinoblastoma from 2013 to 2017 were reviewed and their demographic details, clinical presentation, and treatment outcomes were analysed. RESULTS Thirteen tumours from ten eyes of ten patients were included. Mean age at diagnosis was 36 months (median = 30, range = 2-60 months). Mean number of cavities per tumour were two (median 1, range 1-5). Sixty-two percent of tumours had primary cavities, 23% had secondary cavities, while 15% had both types. Mean basal tumour diameter at presentation was 10.9 mm, and at final follow-up was 10.4 mm. Mean tumour thickness at presentation was 7.7 mm, and at final follow-up was 6.5 mm. Majority of tumours (46%) showed type 2 regression pattern. Tumour recurrence was noted in 1(8%) eye. Cavity rupture with release of vitreous seeds was observed in one eye. Two (20%) eyes with vitreous seeds were treated with intravitreal chemotherapy. Two eyes were advised enucleation, one due to tumour recurrence and the other due to persistent vitreous seeds. No patients had metastasis or death. Mean follow-up was 54 months (median 20, SD 66.82, range 3-183). CONCLUSION Cavitary tumours have variable presentations, are often associated with vitreous seeds, and in some cases the latter emanates from them as well. Cavitary tumours tend to maintain stable tumour dimensions.
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Affiliation(s)
- Pukhraj Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, 600006, India.
| | - Unnati Sharma
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, 600006, India
| | - Tarun Sharma
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, 600006, India
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7
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Stathopoulos C, Sergenti J, Gaillard MC, Munier FL, Daruich A. Pars plana vitrectomy under melphalan irrigation for recurrent retinal detachment in eyes treated for retinoblastoma: a case report. BMC Ophthalmol 2020; 20:34. [PMID: 31992247 PMCID: PMC6986012 DOI: 10.1186/s12886-020-1315-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 01/13/2020] [Indexed: 11/15/2022] Open
Abstract
Background Tractional retinal detachment with or without secondary tear is a rare complication reported in less than 0.5% of in eyes treated for retinoblastoma. Pars plana vitrectomy (PPV) in eyes with history of retinoblastoma has been associated with a significant risk for recurrence, extraocular spread, and systemic metastases. We report here the successful management by PPV under melphalan irrigation of 2 children presenting with tractional retinal detachment after retinoblastoma therapy and scleral buckle surgery. Case presentation A 7-year-old girl with a history of bilateral retinoblastoma (group D) presented with light perception best-corrected visual acuity (BCVA) and tractional retinal detachment (RD) in her left eye, 3 years after the last intra-arterial chemotherapy (IAC) injection. Moreover, she had history of left eye rhegmatogenous RD treated by scleral buckle 1 month after the last IAC and cataract surgery 12 months later. PPV associated with retinectomy, laser photocoagulation and silicone oil tamponade was performed. Silicone oil was removed 4 months later. Fifteen months after PPV, BCVA had increased to 20/32 without recurrence of RD and no evidence of tumor activity. A 7-year-old boy with a history of unilateral retinoblastoma (group D) in his left eye presented with rhegmatogenous RD 21 months after the last treatment for retinoblastoma. Scleral buckle surgery was performed, but 3 weeks later the patient presented with tractional RD associated with proliferative vitreo-retinopathy. BCVA was counting fingers. PPV associated with membrane peel, laser photocoagulation and silicone oil tamponade was performed. Silicone oil was removed after 5 months followed by cataract surgery 5 months later. Twenty months after PPV, BCVA was 20/20 and there was no sign of tumor recurrence. Conclusions PPV under melphalan irrigation, with retinectomy, if necessary, and silicone oil tamponade, allows anatomical and functional improvement in eyes with history of retinoblastoma and scleral buckling developing tractional RD.
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Affiliation(s)
- Christina Stathopoulos
- Department of ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Jessica Sergenti
- Department of ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Marie-Claire Gaillard
- Department of ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Francis L Munier
- Department of ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Alejandra Daruich
- Department of ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland. .,Ophthalmology Department, Necker-Enfants Malades University Hospital, APHP, Paris Descartes University, 149 rue de Sèvres, 75015, Paris, France.
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8
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Munier FL, Beck-Popovic M, Chantada GL, Cobrinik D, Kivelä TT, Lohmann D, Maeder P, Moll AC, Carcaboso AM, Moulin A, Schaiquevich P, Bergin C, Dyson PJ, Houghton S, Puccinelli F, Vial Y, Gaillard MC, Stathopoulos C. Conservative management of retinoblastoma: Challenging orthodoxy without compromising the state of metastatic grace. "Alive, with good vision and no comorbidity". Prog Retin Eye Res 2019; 73:100764. [PMID: 31173880 DOI: 10.1016/j.preteyeres.2019.05.005] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/25/2019] [Accepted: 05/29/2019] [Indexed: 12/21/2022]
Abstract
Retinoblastoma is lethal by metastasis if left untreated, so the primary goal of therapy is to preserve life, with ocular survival, visual preservation and quality of life as secondary aims. Historically, enucleation was the first successful therapeutic approach to decrease mortality, followed over 100 years ago by the first eye salvage attempts with radiotherapy. This led to the empiric delineation of a window for conservative management subject to a "state of metastatic grace" never to be violated. Over the last two decades, conservative management of retinoblastoma witnessed an impressive acceleration of improvements, culminating in two major paradigm shifts in therapeutic strategy. Firstly, the introduction of systemic chemotherapy and focal treatments in the late 1990s enabled radiotherapy to be progressively abandoned. Around 10 years later, the advent of chemotherapy in situ, with the capitalization of new routes of targeted drug delivery, namely intra-arterial, intravitreal and now intracameral injections, allowed significant increase in eye preservation rate, definitive eradication of radiotherapy and reduction of systemic chemotherapy. Here we intend to review the relevant knowledge susceptible to improve the conservative management of retinoblastoma in compliance with the "state of metastatic grace", with particular attention to (i) reviewing how new imaging modalities impact the frontiers of conservative management, (ii) dissecting retinoblastoma genesis, growth patterns, and intraocular routes of tumor propagation, (iii) assessing major therapeutic changes and trends, (iv) proposing a classification of relapsing retinoblastoma, (v) examining treatable/preventable disease-related or treatment-induced complications, and (vi) appraising new therapeutic targets and concepts, as well as liquid biopsy potentiality.
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Affiliation(s)
- Francis L Munier
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland.
| | - Maja Beck-Popovic
- Unit of Pediatric Hematology-Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Guillermo L Chantada
- Hemato-Oncology Service, Hospital JP Garrahan, Buenos Aires, Argentina; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - David Cobrinik
- The Vision Center and The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA; USC Roski Eye Institute, Department of Biochemistry & Molecular Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Tero T Kivelä
- Department of Ophthalmology, Ocular Oncology and Pediatric Ophthalmology Services, Helsinki University Hospital, Helsinki, Finland
| | - Dietmar Lohmann
- Eye Oncogenetics Research Group, Institute of Human Genetics, University Hospital Essen, Essen, Germany
| | - Philippe Maeder
- Unit of Neuroradiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Annette C Moll
- UMC, Vrije Universiteit Amsterdam, Department of Ophthalmology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Angel Montero Carcaboso
- Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Alexandre Moulin
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Paula Schaiquevich
- Unit of Clinical Pharmacokinetics, Hospital de Pediatria JP Garrahan, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Ciara Bergin
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Paul J Dyson
- Institut des Sciences et Ingénierie Chimiques, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015, Lausanne, Switzerland
| | - Susan Houghton
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Francesco Puccinelli
- Interventional Neuroradiology Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Yvan Vial
- Materno-Fetal Medicine Unit, Woman-Mother-Child Department, University Hospital of Lausanne, Switzerland
| | - Marie-Claire Gaillard
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Christina Stathopoulos
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
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Management of retinal detachment in retinoblastoma with globe conserving treatment. J Curr Ophthalmol 2018; 31:43-48. [PMID: 30899845 PMCID: PMC6407070 DOI: 10.1016/j.joco.2018.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/20/2018] [Accepted: 09/05/2018] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the features and outcomes of retinoblastoma (Rb) patients complicated by development of retinal detachment (RD) following systemic chemotherapy with or without local focal consolidation treatment and without external beam radiotherapy (EBRT). Methods A retrospective study of all Rb patients between April 2002 and April 2012 at a tertiary hospital center (Birmingham Children's Hospital and Birmingham Midlands Eye Centre, United Kingdom). All eyes that had developed RD during or after systemic treatment with or without local focal consolidation treatment were included in the study. The time interval between the type of treatment of Rb, development of RD and relevant surgical intervention were analyzed. Patients with exudative RD were treated conservatively through observation and patients with rhegmatogenous RD were treated with scleral buckling. Final anatomical retinal reattachment rate and visual acuity outcomes were analyzed. Results A total of 258 patients were treated for Rb over the 10-year period. One hundred sixty-nine patients were managed with globe conserving treatment. Ten (5.92%) eyes of 10 patients were complicated with RD. Five eyes were exudative or presumed exudative type of RD while the other five eyes were rhegmatogenous or presumed rhegmatogenous RD. In the exudative group, two patients achieved visual acuity (VA) of 0.2 Single Kays (20/32 Snellen), and the other two patients achieved 0.85 and 0.86 Crowded Kays (20/142 and 20/145 Snellen), respectively, after the RD had resolved. The last patient in the group had to be enucleated due to tumor recurrences. The median time for the exudative RD to resolve is 15 weeks (range, 4-36 weeks). In the rhegmatogenous group, 3 of the 4 operated patients achieved retinal reattachment. The final postoperative VA ranged between 0.05 Crowded Kays to 1.84 Crowded Kays (20/22 to 20/1384 Snellen). The other patient was treated conservatively as no retinal breaks were found with previous cryotherapy and thermotherapy. The final VA in this patient was hand movement, and the RD did not reattach. The median time for the rhegmatogenous RD to reattach is 6 weeks (range, 4-8 weeks). There were no intra- and postoperative complications. Conclusions With long-term conservative management through observation, exudative Rb after systemic treatment of Rb will tend to resolve by itself. However, supplementary local treatment with cryoretinopexy or laser photocoagulation during the systemic treatment of Rb can lead to an increased risk of rhegmatogenous RD. In these cases, most rhegmatogenous RD are successfully repaired with non-drainage scleral buckling and cryoretinopexy.
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Abstract
OBJECTIVE To evaluate the clinical and histopathologic characteristics of patients who develop proliferative vitreoretinopathy after retinoblastoma treatment. DESIGN Retrospective review of three cases of proliferative vitreoretinopathy (PVR) that developed after successful treatment of retinoblastoma from 2003 to 2015. SUBJECTS Three patients with treated retinoblastoma who developed severe PVR and required enucleation. METHODS Review of clinical charts, fundus drawings, Ret-Cam 3 images, and histopathology specimens. MAIN OUTCOME MEASURES Clinical and histopathologic characterization of PVR in treated retinoblastoma. RESULTS Three patients developed severe PVR after sequential thermal laser combined with systemic chemotherapy for retinoblastoma. At presentation patients were 6, 7, and 9 months of age, and all had bilateral retinoblastoma. Time to development of proliferative tissue was 9, 12, and 20 months after initial treatment. Proliferation was characterized by progressive growth of white vascularized tissue with associated traction on the retina and sometimes hemorrhage. All patients underwent enucleation. Histopathologic evaluation revealed treated retinoblastoma tumor with a Type 3 regression pattern, pre- and subretinal fibrovascular tissue consistent with PVR, and reactive changes in the retinal pigment epithelium. None of the patients developed recurrence of retinoblastoma or systemic metastasis. CONCLUSION PVR uncommonly develops after successful treatment of retinoblastoma and may result in traction or rhegmatogenous retinal detachment along with vitreous hemorrhage. Early stages of proliferation may be difficult to distinguish from recurrent tumor. Enucleation may be required due to poor vision and inability to adequately monitor for tumor recurrence.
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Yousef YA, Manna M, Khalil MB, Nawaiseh I. Surgical repair of rhegmatogenous retinal detachment in eyes harboring active retinoblastoma. Ophthalmic Genet 2016; 37:314-7. [DOI: 10.3109/13816810.2015.1046556] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Yacoub A. Yousef
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Mamdouh Manna
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | | | - Ibrahim Nawaiseh
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
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13
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Three cases of rhegmatogenous retinal detachment associated with regressed retinoblastoma after conservative tumor therapy. Retin Cases Brief Rep 2015; 8:223-6. [PMID: 25372444 DOI: 10.1097/icb.0000000000000049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report three cases of rhegmatogenous retinal detachment associated with regressed retinoblastoma after conservative therapy. METHODS Three eyes of three patients with rhegmatogenous retinal detachment, in which retinal breaks were present at the edge of the tumor scar, were treated with vitrectomy and scleral buckling. RESULTS In two eyes, in which cryopexy and silicone oil injection were performed, a preretinal membrane was formed that was comprised primarily of glial cells. Additional vitrectomy and membrane peeling reattached the retina. In one eye, in which photocoagulation and gas injection were performed, an initial vitrectomy and scleral buckling reattached the retina without postoperative membrane formation. CONCLUSION Vitrectomy and scleral buckling contributed to closure of the irregularly shaped retinal tear at the edge of the tumor scar. Photocoagulation and gas injection instead of cryopexy and silicone oil injection may avoid postoperative glial proliferation from the tumor scar.
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Saumya Pal S, Gopal L, Khetan V, Nagpal A, Sharma T. Rhegmatogenous retinal detachment following treatment for retinoblastoma. J Pediatr Ophthalmol Strabismus 2010; 47:349-55. [PMID: 20055334 DOI: 10.3928/01913913-20091218-03] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Accepted: 06/17/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE To elucidate characteristics of rhegmatogenous retinal detachment that developed in children who underwent treatment for retinoblastoma and to analyze the outcome following vitreoretinal surgery in such clinical settings. METHODS This was a retrospective case series of 9 eyes of 9 patients who underwent vitreoretinal surgery for tumor control and retinal reattachment. RESULTS At the time of diagnosis of rhegmatogenous retinal detachment, retinoblastoma was regressed in 6 eyes (67%). The retinal detachment involved less than two quadrants in 7 eyes (78%) and was caused by an atrophic break in 7 eyes. Seven eyes underwent a non-drainage scleral buckling procedure. Three eyes underwent vitreous surgery; in 2 of these eyes, tumor excision along with retinectomy using melphalan infusion was performed and eventually silicone oil tamponade was used. Retinal reattachment was achieved in all eyes with eventual tumor control in 7 eyes. The median follow-up after retinal reattachment surgery was 24 months. CONCLUSION Rhegmatogenous retinal detachment in treated eyes with retinoblastoma is usually caused by an atrophic retinal break. Retinal detachment can be repaired successfully in most eyes.
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Outcomes of cataract surgery following radiation treatment for retinoblastoma. J AAPOS 2009; 13:454-458.e3. [PMID: 19840723 PMCID: PMC3033780 DOI: 10.1016/j.jaapos.2009.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Revised: 05/29/2009] [Accepted: 06/03/2009] [Indexed: 11/22/2022]
Abstract
PURPOSE To report the outcomes after cataract extraction in eyes previously treated for retinoblastoma. METHODS We reviewed the medical records of consecutive patients treated with cataract extraction at our institution for radiation-induced cataract following retinoblastoma treatment between 1992 and 2007. RESULTS Twelve eyes of 11 patients were included. The median age at diagnosis of retinoblastoma was 7.4 months. The median quiescent interval before cataract surgery was 34.6 months (range, 17-240 months). All patients underwent limbal-based extracapsular cataract extraction with scleral-tunnel wound construction. Anterior vitrectomy and posterior capsulotomy were performed in 7 eyes; an intraocular lens was placed in 10 eyes. A laser capsulotomy was subsequently performed in 5 eyes. No postoperative complications occurred. One patient underwent a pars plana vitrectomy for vitreous hemorrhage and proliferative retinopathy 5 years after cataract extraction. The median follow-up after surgery was 6.0 years (range, 1.1-12.3 years). Final visual acuity was between 20/20 and 20/60 in 6 eyes, between 20/70 and 20/200 in 2 eyes, and worse than 20/200 in 4 eyes. No intraocular tumor recurrences or metastases occurred. Two patients developed secondary rhabdomyosarcomas; 1 patient succumbed to the disease. CONCLUSIONS Limbal-based cataract extraction in our series was not associated with tumor recurrence or metastasis. The optimal quiescent interval is not known; however, no tumor recurrences occurred in our series when a minimum 17-month quiescent period was achieved. Visual improvement was noted in every patient, although several patients only experienced modest gains.
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Affiliation(s)
- Neelakshi Bhagat
- Institute of Ophthalmology and Visual Science, New Jersey Medical School, Newark, New Jersey, USA
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Abstract
PURPOSE 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. CONCLUSION 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.
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Affiliation(s)
- Khaled A Tawansy
- Children's Retina Institute of California, Glendale, CA 91205, USA.
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Abstract
BACKGROUND As conservative treatments for retinoblastoma become more prevalent, there will be a greater number of ocular complications developing in eyes that previously would have been enucleated. Pars plana vitrectomy (PPV) is needed to manage some of these complications. METHODS The authors evaluated three consecutive cases of PPV in eyes that were successfully treated for retinoblastoma from the Retina Service of the Massachusetts Eye and Ear Infirmary (MEEI) performed between 1989 and 2004. A review of the literature to date regarding PPV after treatment for retinoblastoma was also performed. RESULTS There was no tumor reactivation in the three cases at MEEI. Vision was maintained at light perception in one case, and there was improvement in vision from hand motions to 20/80 and 20/400 to 20/160 in two cases. Twelve of the 24 cases reviewed in the literature were found to have significant complications of recurrent tumor, need for enucleation, and/or systemic metastasis. CONCLUSION PPV is associated with significant risks in eyes previously treated for retinoblastoma and should be reserved for monocular patients with no other alternative for retaining visual function. Areas that may influence outcome include different treatment modalities and length of time of documented tumor inactivity before PPV.
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Affiliation(s)
- Scott M Warden
- Retina Service, Massachusetts Eye and Ear Infirmary, and Department of Ophthalmology, Harvard Medical School, Boston, MA 02114-3096, USA
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Buerk BM, Lai WW, Sharma MC, Shapiro MJ. Minimally Invasive Method for Repair of Rhegmatogenous Retinal Detachment Following Treatment for Retinoblastoma. Ophthalmic Surg Lasers Imaging Retina 2006. [DOI: 10.3928/1542-8877-20060101-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Shields CL, Meadows AT, Leahey AM, Shields JA. Continuing challenges in the management of retinoblastoma with chemotherapy. Retina 2005; 24:849-62. [PMID: 15579981 DOI: 10.1097/00006982-200412000-00003] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The management of retinoblastoma has gradually changed over the past 10 years. Over 95% of children with retinoblastoma in the United States are cured with modern techniques. The challenge remains, however, in maintaining the eye and vision. There is a trend away from enucleation and external beam radiotherapy toward focal conservative treatments involving primary chemoreduction in conjunction with thermotherapy and cryotherapy. This is related to earlier detection of the disease, recognition of more effective chemotherapeutic agents, more focused local treatment modalities, and, most importantly, knowledge of the long-term risks of external beam radiotherapy. Enucleation is still preferable for retinoblastoma that fills most of the eye, especially when the disease is unilateral or when there is concern for tumor invasion into the optic nerve, choroid, or orbit. The orbital integrated implant is placed after enucleation and provides acceptable prosthesis motility and appearance. External beam radiotherapy is still vital for treating advanced retinoblastoma, especially when there is diffuse vitreous or subretinal seeding after failure of other methods and preservation of vision is a priority. The most important recent advance in the management of retinoblastoma is the use of intravenous chemotherapy for tumor reduction, a technique of neoadjuvant chemotherapy termed "chemoreduction." This is followed by tumor consolidation with focal measures such as thermotherapy, cryotherapy, and plaque radiotherapy. This strategy provides reduced tumor volume and often permits consolidation with methods other than radiotherapy. It appears that vision can be preserved in some cases with these methods, avoiding some of the local complications like radiation cataract or macular edema that have been found with radiotherapy techniques. External beam radiotherapy and enucleation can now be avoided in most cases of Reese-Ellsworth groups I (minimal disease) through IV (moderate disease) retinoblastoma. The most advanced stage of retinoblastoma, Reese-Ellsworth group V, continues to provide the greatest difficulty for management, and external beam radiotherapy and enucleation are often employed in addition to chemoreduction to save the child's life. A collaborative prospective study in North America is currently under way to further study the benefits and risks of chemoreduction for minimal, moderate, and advanced retinoblastoma.
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Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
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Scott IU, McCabe CM, Murray TG, Rosa RH, Toledano S, Markoe AM. Eyelid and Scleral Necrosis Following Bare Iridium-192 Seed for Retinoblastoma. Ophthalmic Surg Lasers Imaging Retina 2003. [DOI: 10.3928/1542-8877-20030701-13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Anagnoste SR, Scott IU, Murray TG, Kramer D, Toledano S. Rhegmatogenous retinal detachment in retinoblastoma patients undergoing chemoreduction and cryotherapy. Am J Ophthalmol 2000; 129:817-9. [PMID: 10927003 DOI: 10.1016/s0002-9394(00)00407-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To report the development of rhegmatogenous retinal detachment, with the retinal break adjacent to a cryotherapy scar, in three patients undergoing systemic chemotherapy for intraocular retinoblastoma. METHOD Case series. RESULTS Three patients with intraocular retinoblastoma were referred after poor response to systemic chemotherapy and local cryotherapy; three eyes of these three patients were noted to have rhegmatogenous retinal detachment and active retinoblastoma, with retinal breaks adjacent to cryotherapy scars. CONCLUSION Rhegmatogenous retinal detachment may result from retinal necrosis associated with cryotherapy in the setting of intraocular retinoblastoma treated with systemic chemotherapy and local cryotherapy.
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Affiliation(s)
- S R Anagnoste
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida 33136, USA
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Bovey EH, Fernandez-Ragaz A, Héon E, Balmer A, Munier FL. Rhegmatogenous retinal detachment after treatment of retinoblastoma. Ophthalmic Genet 1999; 20:141-51. [PMID: 10520235 DOI: 10.1076/opge.20.3.141.2283] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine the rate of retinal detachment after treatment of retinoblastoma, to describe the clinical features and management, and to discuss possible pathogenic mechanisms. METHODS We retrospectively analyzed the charts of 80 patients (83 eyes) with retinoblastoma treated conservatively between 1963 and 1994, looking specifically for cases that developed a retinal detachment after treatment. RESULTS Five patients (5 eyes, stages IVa to Vb) developed a retinal detachment after treatment. Of these, four had undergone external radiotherapy and one had an episcleral cobalt plaque. Retinal detachment developed within three months after radiotherapy and relentlessly progressed in all four eyes over a period of five months to four years. In the eye that received the episcleral cobalt plaque, the detachment remained localized inferiorly. Even though no retinal break could be detected in four eyes, the clinical features were suggestive of a rhegmatogenous detachment: there was retinal thinning adjacent to the regressed tumors, and the evolution was much longer than that of an exudative retinal detachment. A scleral buckling procedure was performed in two eyes and the retina was successfully reattached. The retinal detachment was not operated on in the three other eyes: the hole was too posterior in one eye; retinal surgery was refused in the second eye; and the retinal detachment remained localized inferiorly in the third eye. CONCLUSION A retinal detachment developed in 6% of eyes after conservative treatment of retinoblastoma. The possibility of a rhegmatogenous origin should be considered even if no retinal break is detected. In the absence of tumor activity, a scleral buckling repair could be carefully considered if the retinal detachment threatens the macula, and if its evolution is not indicative of an exudative detachment.
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Affiliation(s)
- E H Bovey
- Hôpital Ophtalmique Jules Gonin Lausanne, Switzerland
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