Effectiveness of intravitreal chemotherapy-assisted endoresection in monocular patients with group D retinoblastoma
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RESEARCH ARTICLE
Open Access
Effectiveness of intravitreal chemotherapyassisted endoresection in monocular patients with group D retinoblastoma Xiling Yu, Xueke Li, Yue Xing, Siduo Lu, Silvia Tanumiharjo and Jin Ma*
Abstract Background: This study aimed to determine the efficacy and complications of intravitreal chemotherapy-assisted endoresection for refractory International Classification of Retinoblastoma (ICRB) group D retinoblastoma in monocular patients. Methods: In this retrospective case series, intravitreal chemotherapy-assisted endoresection by pars plana vitrectomy was performed in 11 eyes with refractory ICRB group D retinoblastoma unresponsive to standard therapies in monocular patients. Results: Across a mean follow-up period of 42.7 months, globe salvage was attained in all 11 eyes (100%). There were no cases of extra-ocular tumour seeding or remote metastasis. In 9 eyes (81.8%), tumour control was achieved with one pars plana vitrectomy; in 2 cases (18.2%), repeated treatment, such as laser therapy, intravitreal chemotherapy or a second pars plana vitrectomy, was needed. Retinal reattachment was achieved in all 4 eyes (100%) with previous retinal detachment. Four eyes (36.4%) required subsequent cataract surgery due to secondary cataract. Ten eyes (90.9%) had improvement in best-corrected visual acuity at the last follow-up. Conclusion: Intravitreal chemotherapy-assisted endoresection appears to be a safe and effective globe-salvaging method for refractory group D retinoblastoma. It is a promising alternative to enucleation and a supplementary therapeutic strategy for those unresponsive to standard therapies, especially for the monocular retinoblastoma patients. Keywords: Refractory retinoblastoma, Intravitreal chemotherapy, Endoresection, Pars plana vitrectomy
Background Over the past two decades, the management of retinoblastoma has dramatically changed from eye-sacrificing methods to eye-preserving alternatives [1]. Eye preservation can be achieved in as much as 90–100% of eyes classified as group A, B or C retinoblastoma, but it is still challenging in group D and E retinoblastoma classified according to the International Classification of Retinoblastoma (ICRB) criteria [2]. Recent research has suggested that it is safe to attempt eye-preserving methods * Correspondence: [email protected] Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
for group D cases, while enucleation is still recommended for group E cases [3]. Recent studies have shown some progress in the globe salvage of group D retinoblastoma with the single or combined use of intravenous chemotherapy (IVC), intra-arterial chemotherapy (IAC) and intravitreal chemotherapy (IViC), but persistent or recurrent vitreous and subretinal seeding can still occur in some refractory cases [4]. Eye preservation is especially important for monocular patients for whom the other affected eye has been previously enucleated for unmanageable progressive retinoblastoma and who require the rem
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