scholarly journals Results of cataract surgery in children with retinoblastoma

2021 ◽  
pp. 65-70
Author(s):  
A.A. Yarovoy ◽  
◽  
V.A. Yarovaya ◽  
I.G. Osokin ◽  
E.S. Kotova ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Tumor Regression ◽  
External Beam Radiotherapy ◽  
Local Treatment ◽  
Functional Results ◽  
Treatment Modalities ◽  
Complete Regression ◽  
Intravitreal Chemotherapy ◽  
Optical Media

Purpose. To present results of cataract surgery in children with retinoblastoma. Material and methods. Within the period from 2012 to 2020, cataract surgery was performed in 21 children (22 eyes) with retinoblastoma aged 28 to 155 months (average – 65 months). Tumors of group B occurred in 2 cases, group C – in 4, group D – in 14, group E – in 1. In 8 cases, cataract occurred in a single eye. Posterior capsular cataract was observed in 18 patients, total – in 3. In all cases, the presence of cataract impeded the control of the tumor. Before cataract surgery all children underwent systemic chemotherapy, some of them also underwent intra-arterial and/or intravitreal chemotherapy, external beam radiotherapy, Gamma Knife stereotactic radiosurgery and local treatment modalities (episcleral plaque brachytherapy, thermotherapy, cryotherapy). There were no signs of tumor progression in all cases at the time of cataract surgery. The mean interval between complete tumor regression and cataract surgery was 23 months (range 6–75 months). Results. Full transparency of optical media was achieved in all eyes after surgery. No intraoperative and postoperative complications occurred. The final visual acuity was improved in 12 eyes, in the rest visual acuity could not be determined due to age. There were no signs of tumor recurrence or metastases in mean follow-up after surgery of 29 months (range 3–60). Conclusion. Our experience of cataract surgery in children with complete regression of retinoblastoma was proved to be a safe and effective way to improve visual functions and achieve transparency of optical media. Key words: retinoblastoma, cataract surgery, ophtalmooncology, functional results

scholarly journals Gamma Knife stereotactic radiosurgery for intraocular retinoblastoma: a 5-year experience

2021 ◽  
pp. 46-56
Author(s):  
A.A. Yarovoy ◽  
◽  
A.V. Golanov ◽  
T.L. Ushakova ◽  
V.V. Kostyuchenko ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Malignant Tumors ◽  
External Beam Radiotherapy ◽  
Local Treatment ◽  
Vitreous Hemorrhage ◽  
Treatment Modalities ◽  
Complete Regression ◽  
Group B ◽  
Gamma Knife Stereotactic Radiosurgery

External beam radiotherapy (EBR) remained for a long time the only method of treatment in children with recurrent and resistant retinoblastoma (RB). This method often leads to serious complications, including the occurrence of secondary malignant tumors. Currently, EBR is used as second-line (salvage) therapy. There is no data in the literature of using Gamma Knife stereotactic radiosurgery (GKRS) in RB treatment. Purpose. To present 5-year experience of using GKRS in patients with RB. Material and methods. 16 children (17 eyes) were treated using GKRS in the period from 2015 to 2019. Mean patient age was 34.7 months (range, 12–114 months). The eyes were classified as group B (n=4), C (n=1), D (n=12). 3 children had the last eye. All patients received systemic and local chemotherapy, all types of local treatment modalities before using GKRS. Recurrent and resistant RB was the indication for GKRS. Marginal 50% mean dose was 22 Gу (range, 20–24 Gу), depending on tumour type and location. Radiation doses were evaluated accounting critical eye structures and the orbit bones. Results. Complete regression was achieved in 11 patients, partial in 2. Four patients underwent enucleation after GKRS. Indications for enucleation were retinoblastoma recurrence (n=2) and vitreous hemorrhage with total retinal detachment (n=2). 13 eyes were salvaged with no signs of keratopathy, uveitis or damage of orbital and surrounding tissues during mean follow-up 30.6 months (range, 7–60 months). Сomplications of different severity occurred in 13 patients, including vitreous hemorrhage in 6 patients, which was successfully treated both conservative (n=3) and using pars plana vitrectomy with simultaneous melphalan irrigation (n=3). Conclusion. The first experience of GKRS as an alternative to enucleation in patients with RB was proved to be reasonable and successful. Key words: retinoblastoma, gamma-knife, stereotactic radiosurgery.

Cataract surgery in treated retinoblastoma eyes: A study of 29 eyes

2020 ◽  
pp. 112067212093857
Author(s):  
Swathi Kaliki ◽  
Arpita Maniar ◽  
Ramesh Kekunnaya
Keyword(s):  
Cataract Surgery ◽  
Tumor Regression ◽  
External Beam Radiotherapy ◽  
Cataract Extraction ◽  
Time Interval ◽  
Visual Axis ◽  
Tumor Extension ◽  
Post Surgery ◽  
Group B ◽  
Tumor Edge

Purpose: To study the outcomes of cataract surgery in treated retinoblastoma (RB) eyes. Methods: Retrospective study of 29 eyes of 27 patients. Results: Based on International Classification of Intraocular Retinoblastoma, tumors belonged to group B ( n = 3, 10%), C ( n = 1, 4%), D ( n = 10, 34%), and E ( n = 3, 10%). The remaining 12 eyes (41%) had regressed tumors on presentation due to prior treatment. The RB treatment details included intravenous chemotherapy ( n = 24, 83%), external beam radiotherapy ( n = 14, 48%), and others. The mean time interval between tumor regression and cataract surgery was 51 months (median, 26 months; range, 6–245 months). The post-operative visual acuity was 20/200 or better in 12 (41%) eyes. Overall, 16 (55%) eyes displayed improvement of vision post-cataract surgery, while 13 (45%) eyes had no improvement in vision. The complications of cataract surgery included visual axis opacification ( n = 15, 52%), pupillary membrane ( n = 4, 14%), hyphema ( n = 1, 3%), and extraocular tumor extension ( n = 1, 3%). Clearer fundus view post-surgery revealed underlying tumor edge recurrence in 1 (3%) eye, and two (7%) patients had tumor recurrence at a mean interval of 8 months (median, 8 months; range, 7–8 months) following cataract extraction. Globe salvage was achieved in 26 (90%) eyes over a mean follow-up period of 103 months (median, 91 months; range, 19–267 months). Conclusion: Cataract surgery in treated RB is safe with vision salvage in 55% eyes and globe salvage in 90% eyes. Though there is a risk of extraocular tumor extension, its occurrence is rare (3%).

Outcomes of hypofractionated palliative radiotherapy for choroidal metastases.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 194-194
Author(s):  
Ezra Hahn ◽  
Juan Pablo Velazquez-Martin ◽  
Sohel Somani ◽  
Pedro Salazar ◽  
Daniela Domville ◽  
...  
Keyword(s):  
Overall Survival ◽  
Visual Acuity ◽  
Tumor Regression ◽  
External Beam Radiotherapy ◽  
Palliative Radiotherapy ◽  
Local Tumor Control ◽  
Cancer Center ◽  
Tumor Control ◽  
Local Tumor ◽  
Fractionation Schedule

194 Background: External beam radiotherapy (RT) is an effective palliative treatment for choroidal metastases aimed at preserving vision and obtaining local tumor control. Delivery of 30-40 Gy in 2 Gy daily fractions is a standard approach in many centers. At our center, a shorter, more convenient schedule of 20 Gy in 5 fractions has been used in this palliative setting. This study reports the efficacy and toxicity of this hypofractionated RT approach. Methods: We conducted a retrospective review of patients treated in the Ocular Oncology clinic at Princess Margaret Cancer Center who received RT (20 Gy in 5 fractions) for choroidal metastases between January 1, 1999 and November 30, 2012. Primary outcome measures were change in visual acuity and tumor response. Secondary outcomes included toxicities of RT, tumor control, and overall survival from the date of choroidal metastases diagnosis. Results: A total of 55 patients with 71 involved eyes were included. Decreased vision was the presenting symptom in 43 eyes (61%). Visual acuity improved from a median of 20/70 to 20/40 between baseline assessment and last follow-up, and remained stable or improved in 56 eyes (80%). On ultrasound, tumor regression was observed in 64 eyes (91%) with complete response in 47 eyes (67%). Metastases progressed in 4 eyes (6%) despite RT with 1 eye requiring enucleation. Median survival after diagnosis of choroidal metastases was 13 months with estimated overall survival at 1, 2, and 3 years to be 50% (36-62), 23% (12-35), and 8% (3-18), respectively. Forty-nine patients (89%) did not experience any acute complications. Mild acute toxicities included transitory dryness in 5 patients and episcleritis in 1 patient. Cataracts developed in 4 eyes (6%), retinopathy in 1 eye, optic neuropathy in 7 eyes (10%), pigmentary maculopathy in 5 eyes (7%), and neovascular glaucoma in 1 eye. Conclusions: A short fractionation schedule of 20 Gy in 5 fractions is a well-tolerated treatment that effectively preserves vision and gains local tumor control for many patients with choroidal metastases. This hypofractionated approach would help reduce the burden of a longer treatment course in this palliative patient population.

scholarly journals Retinoblastoma: a patient’s story

2020 ◽  
Vol 7 (2) ◽  
pp. 134-139
Author(s):  
A. A. Yarovoy ◽  
T. L. Ushakova ◽  
O. V. Golubeva ◽  
I. A. Levashov ◽  
S. N. Mikhailova ◽  
...  
Keyword(s):  
External Beam Radiotherapy ◽  
Vitreoretinal Surgery ◽  
Vitreous Hemorrhage ◽  
Treatment Modalities ◽  
Current Therapy ◽  
External Beam ◽  
Intravitreal Chemotherapy ◽  
Second Tumors ◽  
History Of ◽  
The One

Relevance. Development and application of novel treatment methods for patients with retinoblastoma (Rb) is a great task since it may provide higher rates of eye salvage and reduce adverse effects of current therapy.Aim of the study was to represent the history of Rb eye-sparing treatment in Russia and worldwide through the one clinical case.Materials and methods. A child was treated by systemic chemotherapy, plaque brachytherapy using non-described techniques, cryotherapy and external beam radiotherapy. Intravitreal chemotherapy was approached for treatment of vitreous seeding. Vitreoretinal surgery with melphalan irrigation was successfully performed after failure of vitreous hemorrhage conservative treatment and parents’ refusal to indicated enucleation. The child died from CNS disseminated esthesioneuroblastoma.Results. The use of various treatment modalities helped to save the single eye.Conclusions. Intravitreal chemotherapy was introduced in Russia for the first time. Performed vitreoretinal surgery with melphalan irrigation was proved to be a safe and effective technique in case of vitreous hemorrhage in the eye with Rb. External beam therapy is associated with fatal second tumors development.

Delayed metastasis in patients with intraocular retinoblastoma: A review of three cases

2020 ◽  
pp. 112067212094628
Author(s):  
Vijitha S Vempuluru ◽  
Saumya Jakati ◽  
Swathi Kaliki
Keyword(s):  
Metastatic Disease ◽  
Tumor Regression ◽  
External Beam Radiotherapy ◽  
Case Series ◽  
Surgical Excision ◽  
Primary Treatment ◽  
Retrospective Case ◽  
Temporal Fossa ◽  
Intravitreal Chemotherapy

Purpose: To discuss the clinical presentation, management, and outcome of delayed metastasis in retinoblastoma (RB). Methods: Retrospective case series of three patients. Results: Mean age at diagnosis of RB was 29 months (median, 28 months; range, 11–48 months). All were males with non-familial bilateral intraocular RB. Primary treatment for RB included intravenous chemotherapy in all three cases. Secondary treatment included transpupillary thermotherapy/cryotherapy ( n = 6 eyes), periocular chemotherapy ( n = 2 eyes), intravitreal chemotherapy ( n = 1 eye), intra-arterial chemotherapy ( n = 1 eye), external beam radiotherapy (EBRT; n = 2 eyes), and enucleation ( n = 2 eyes). Primary tumor regression was achieved in all cases and remained status quo at the time of diagnosis of distant metastasis. Two patients developed bone metastasis (ulna; tibia) and one developed soft tissue metastasis (temporal fossa) over a mean follow-up period of 6 years (median, 7 years; range, 5–8 years) from diagnosis of RB. Mean age of detection of metastatic disease was 8 years (median, 8 years; range, 7–9 years). All the lesions were solitary and the diagnosis of metastatic retinoblastoma was confirmed by tissue biopsy. Metastatic disease was treated with surgical excision ( n = 1), chemotherapy ( n = 2), and EBRT ( n = 2). All patients are alive, with two patients free of disease over a mean follow-up period of 23 months (median, 23 months; range, 12–33 months); and 1 in remission 7 months after completion of EBRT. Conclusion: Long-term follow-up of RB cases is mandatory. In spite of intraocular tumor regression, metastasis can still occur many years after treatment of RB.

CLINICAL CHARACTERISTICS AND RESULTS OF CATARACT SURGERY IN THE SMALL PUPIL EYE BY PHACOEMUSIFICATION

2018 ◽  
pp. 79-82
Author(s):  
Van Minh Pham ◽  
Van Nam Phan ◽  
Thi Thu Nguyen
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Clinical Characteristics ◽  
Low Vision ◽  
Sample Selection ◽  
Posterior Chamber ◽  
Good Visual Acuity ◽  
Before And After ◽  
Grade Ii ◽  
Small Pupil

Objectives: To investigate the clinical characteristics of cataract patients with small pupils and to evaluate the result of cataract surgery on the eye have small pupils by phacotechnique. Subjects and methods: Descriptive study, prospective, uncontrolled interventions. Sample selection. The sample size of 70 patients with 70 eyes of cataracts with small pupils was treated by phaco technique and intraocular lens implant within posterior chamber. Follow up to 3 months. Results: 70 eyes, the percentage of men and women was not different from 54.2% (38 male) compared to 45.8% (32 female). The mean age was 80 ± 8.74, from 58 to 99 years. The disease was mainly found in the age group over 70 years old with over 80% (51.5%). Visual acuity before surgery was very poor under 3m CF (count finger) for 68.6% (48/70). Visual acuity over 1/10 was only a small amount with 2.8% (2 eyes). Pseudoexfoliation was the most common reason complications of mydriasis with 32/70 eyes (45.7%) and 22/70 eyes (31.4%) for age. The preoperative pupilarysizewas mostly small with 63/70 eyes (90.0%), non-dilated pupils (7/70 eyes) (10.0%). Average pupil size was 3.34 mm (2 - 4mm). Iris condition: iris atrophy 20/10 eyes (28.6%), iris synechiae 11/10 (15.7%), irregular iris muscle with 51, 4% and good iris muscle accounted for 48.6%. Grade of cataract: Grade III: 31/70 eyes (44.3%), Grade IV: 32/70 eyes (45.7%), Grade II: 5/70 eyes (7.1%) and V:2/70 eyes (2.9%). Pupil expander technique: OVD injection with 42/70 eyes (60%), using iris hook with 23/70 eyes (32.9%). Pupillary size before and after intervention has changed from 3.7mm to 4.48mm. Conclusions: Iris expander techniques have been shown to have good dilated pupils: 60.0% OVD injection, iris hook was 32.9%, other methods 7.1% One-week visibility of good visual acuity was higher than that of postoperative one day (12.2%) and increased at 1 month and 3 months (20.0%). Very good visual acuity was not available and low vision group was 1.4% after 3 months. Key words: cataract surgery; phacoemusification, small pupil

Pediatric Cataract Surgery: Comparison between Ages at Surgery and Contrast Sensitivity Outcomes

2019 ◽  
Vol 43 (1) ◽  
pp. 50
Author(s):  
Aquirina Caesari Putri ◽  
Rozalina Loebis
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Contrast Sensitivity ◽  
Cataract Extraction ◽  
Significant Negative Correlation ◽  
Natural World ◽  
P Value ◽  
Pediatric Cataract ◽  
Low Contrast ◽  
Significant Difference

Background: Pediatric cataracts are major causes of children’s blindness. Surgery has proven to be beneficial in terms of visual function prognosis. Contrast sensitivity evaluation after surgery is as important as visual acuity considering that natural world consists of various objects in low-to-medium contrasts. The purpose of this study is to analyze the difference of contrast sensitivity outcomes based on ages at surgery. Method: Retrospective data of children with pediatric developmental cataract from July 2013 to November 2015 were collected. All children who underwent cataract surgery at 60-months-old or less were randomized into two groups, ≤24 months and >24-to-60 months. Contrast sensitivity was then examined with preferential-looking method using Hiding Heidi low-contrast test face chart. The main outcome measures were contrast sensitivity of both groups. Age-at-evaluation, cataract onset, duration of follow-up, duration of deprivation and visual acuity were also noted. Result: Of 14 children (23 eyes), 11 eyes (47,8%) were in ≤24 months group, 12eyes (52,2%) were in >24-to-60 months group. All eyes underwent cataract extraction and similar type of intraocular lens implantation. Mean age-at-surgery was 28,2 months±16,8 (SD). Mean contrast sensitivity for each group was 47,50 %±42,29 and 18,33%±27,38, respectively, with p-value 0,031. Further analysis of Spearman’s correlation test demonstrated significant negative correlation (rs = -0,559; p = 0,006) between the two groups. Conclusion: There was statistically significant difference in contrast sensitivity between those who underwent surgery at ≤24 months and >24-to-60 months. Children who underwent surgery at older ages tend to have better contrast sensitivity afterwards.

Successful Treatment of Late Isolated Bone Metastasis in a Patient with Bilateral Retinoblastoma Using an Unconventional Method

2021 ◽  
pp. 1-5
Author(s):  
Deepthi Boddu ◽  
Priyakumari Thankamony ◽  
Reshma Prakasam ◽  
Subin Sugath ◽  
Aswin Kumar ◽  
...  
Keyword(s):  
Treatment Approach ◽  
Treatment Modalities ◽  
Complete Regression ◽  
Aggressive Treatment ◽  
Second Malignancies ◽  
Transpupillary Thermotherapy ◽  
Metastatic Recurrence ◽  
Bilateral Retinoblastoma ◽  
Unconventional Method

Though survival in bilateral retinoblastoma (RB) has improved due to advancement in diagnostics and treatment modalities, children require long-term follow-ups for recurrence and second malignancies. We report a case of bilateral RB in a 7-month-old baby who was treated with chemotherapy, transpupillary thermotherapy, and periocular carboplatin for both eyes following which there was complete regression of tumour. Six and a half years after treatment, the child presented with metastatic recurrence of tumour in the left ulna. He was treated successfully with chemotherapy, extracorporeal radiation and reimplantation therapy. A less aggressive treatment approach for isolated bone relapse may be considered in selected cases.

scholarly journals Outcomes of Femtosecond Laser Assisted Cataract Surgery Performed by Resident and Attending Surgeons

2021 ◽  
Vol 13 (01) ◽  
pp. e26-e31
Author(s):  
Spencer C. Cleland ◽  
Daniel W. Knoch ◽  
Jennifer C. Larson
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Cataract Surgery ◽  
Retrospective Chart Review ◽  
Dissipated Energy ◽  
Independent Practice ◽  
Postoperative Visual Acuity ◽  
Included Patient ◽  
Duration Of Surgery ◽  
The Difference

Abstract Objective The study aimed to evaluate the safety and efficacy of resident surgeons performing femtosecond laser assisted cataract surgery (FLACS). Methods A retrospective chart review was conducted at the University of Wisconsin-Madison from postgraduate year four residents performing FLACS between 2017 and 2019. Data were also collected from residents performing manual cataract surgery, and attending surgeons performing FLACS for comparison. Recorded data included patient demographics, pre- and postoperative visual acuity, pre- and postoperative spherical equivalent, nuclear sclerotic cataract grade, ocular and systemic comorbidities, intraocular lens, duration of surgery, cumulative dissipated energy (CDE), and intraoperative and postoperative complications. Results A total of 90 cases were reviewed with 30 resident manual cases, 30 resident FLACS cases, and 30 attending FLACS cases. Resident manual (25.5 ± 6.8 minutes) and resident FLACS (17.5 ± 7.1 minutes) cases took a significantly longer time to complete compared with attending FLACS cases (13.6 ± 4.4 minutes; p < 0.001). There was higher CDE in resident FLACS and resident manual cases compared with attending FLACS cases, but the difference was not statistically significant (p = 0.06). Postoperative visual acuity was not statistically different at 1-day and 1-month after surgery among the three groups. Resident FLACS complications, which included one case requiring an intraoperative suture to close the wound, two cases with intraoperative corneal abrasions, two cases with postoperative ocular hypertension, and one case with cystoid macular edema, were not significantly greater than attending FLACS complications (p = 0.30). Conclusion The FLACS performed by resident surgeons had comparable visual acuity outcomes to FLACS performed by attending surgeons, and to manual cataract surgery performed by resident surgeons. However, resident FLACS cases took significantly longer time to complete, and they were associated with a higher CDE and minor complication rate compared with attending FLACS cases. Introducing advanced technologies into surgical training curricula improves resident preparedness for independent practice, and this study suggests FLACS can be incorporated safely and effectively into resident education.

scholarly journals Enhancement of the ionoacoustic effect through ultrasound and photoacoustic contrast agents

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Julie Lascaud ◽  
Pratik Dash ◽  
Matthias Würl ◽  
Hans-Peter Wieser ◽  
Benjamin Wollant ◽  
...  
Keyword(s):  
Contrast Agents ◽  
Bragg Peak ◽  
Ion Beam ◽  
External Beam Radiotherapy ◽  
Local Treatment ◽  
Signal Amplitude ◽  
Peak Position ◽  
Photon Absorption ◽  
India Ink

AbstractThe characteristic depth dose deposition of ion beams, with a maximum at the end of their range (Bragg peak) allows for local treatment delivery, resulting in better sparing of the adjacent healthy tissues compared to other forms of external beam radiotherapy treatments. However, the optimal clinical exploitation of the favorable ion beam ballistic is hampered by uncertainties in the in vivo Bragg peak position. Ionoacoustics is based on the detection of thermoacoustic pressure waves induced by a properly pulsed ion beam (e.g., produced by modern compact accelerators) to image the irradiated volume. Co-registration between ionoacoustics and ultrasound imaging offers a promising opportunity to monitor the ion beam and patient anatomy during the treatment. Nevertheless, the detection of the ionoacoustic waves is challenging due to very low pressure amplitudes and frequencies (mPa/kHz) observed in clinical applications. We investigate contrast agents to enhance the acoustic emission. Ultrasound microbubbles are used to increase the ionoacoustic frequency around the microbubble resonance frequency. Moreover, India ink is investigated as a possible mean to enhance the signal amplitude by taking advantage of additional optical photon absorption along the ion beam and subsequent photoacoustic effect. We report amplitude increase of up to 200% of the ionoacoustic signal emission in the MHz frequency range by combining microbubbles and India ink contrast agents.

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