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Santosh G. Honavar, MD; Carol L. Shields, MD; Jerry A. Shields, MD; Hakan Demirci, MD; Thomas J. Naduvilath, MS

Arch Ophthalmol. 2001;119:1613-1621.

Objectives  To analyze the results of intraocular surgery in patients treated for retinoblastoma and to assess the ocular and systemic outcomes.

Design  Retrospective noncomparative case series.

Patients  Forty-five consecutive patients who underwent an introcular surgery after treatment for retinoblastoma.

Main Outcome Measures  (1) Recurrence of retinoblastoma, (2) need for enucleation, and (3) systemic metastasis. Overall outcome was defined as favorable in the absence of any of these measures and unfavorable in the presence of 1 or more.

Results  Thirty-four patients (76%) underwent a single procedure of cataract surgery, a scleral buckling procedure, or pars plana vitrectomy and 11 (24%) underwent a combination of 2 or more surgical procedures. In all, 16 patients (36%) achieved final visual acuity better than 20/200. Unfavorable outcomes included recurrence of retinoblastoma in 14 patients (31%), enucleation in 16 (36%), and systemic metastasis in 3 (7%). Five patients (20%) who underwent cataract surgery, 5 (63%) who underwent a scleral buckling procedure, and 9 (75%) who underwent pars plana vitrectomy manifested an unfavorable outcome. The median interval between completion of treatment for retinoblastoma and intraocular surgery was 26 months in patients with a favorable outcome vs 6 months in those with an unfavorable outcome.

Conclusions  Intraocular surgery after treatment for retinoblastoma may be justified in certain exceptional clinical situations. Cataract surgery is safe and effective in most cases. However, the need for a scleral buckling procedure and pars plana vitrectomy may be associated with a higher risk for recurrence of retinoblastoma, enucleation, and systemic metastasis, and a cautious approach is warranted.

From the Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pa (Drs Honavar, C. L. Shields, J. A. Shields, and Demirci); and the Oncology Service (Dr Honavar) and the Department of Epidemiology and Biostatistics (Mr Naduvilath), LV Prasad Eye Institute, Hyderabad, India. The authors do not have any proprietary interest in any of the materials and methods used in this study.

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