Retinoblastoma surgery
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Treatment options
- Surgery: The surgery is called enucleation. During the surgery, an orbital implant is also put in to take the place of the eyeball.
Eyes with large tumor burden (Group E eyes) and eyes that progress despite conservative treatments require enucleation. When an eye is enucleated for retinoblastoma, the goal is to remove as much optic nerve as possible to try ensure that the cut end of the nerve is free from tumor. The globe is sent for pathologic evaluation. Pathologic evaluation has clinical importance because it determines whether there are any pathologic risk factors for extraocular spread. Pathologic risk factors (PRF) that have been identified include: 1. choroidal invasion 2. post-laminar invasion of the optic nerve 3. scleral invasion, and 4. involvement of the anterior chamber. If PRFs are present, consideration should be given for adjuvant chemotherapy to decrease the risk of extraocular relapse. At the time of enucleation, the largest orbital implant is placed in order to encourage normal development of the pediatric orbit. Patients who have an eye enucleated will continue to be followed to ensure there is no evidence of tumor in the other eye. They will also need fitting for an ocular prosthesis.
References