Thanks to the treatment of retinoblastoma (RB) having improved significantly in recent years, there is an increasing trend to use conservative treatment modalities that aim to preserve the globe as well as vision with minimum mortality. RB therapy is a long-term systemic treatment in clinical practice. Although there are many treatment options for RB therapy, such as cryotherapy, photocoagulation, systemic chemotherapy, enucleation and ophthalmic chemotherapy, it is recommended to consider in accordance with the following key points in gaining a reasonable treatment strategies: to make sure that RB is an intraocular period; to determine whether the intraocular RB to be treated with eye preservation or enucleation; what is the case of eye preservation therapy combined with chemotherapy and how to arrange the follow-up of RB patients. It's more complicated to choice the therapeutic measures for RB in clinical practice. So, the patient's condition, economic capability and medical condition should be evaluated comprehensively. The principle of RB treatment should be followed, which is protecting eyeball and visual function without life damage.
Prevention and treatment of infants and young children can avoid blindness, effectively reduce the incidence of children's blindness and vision loss. Eye diseases causing blindness in infants and young children mainly include retinopathy of prematurity, retinoblastoma, familial exudative retinopathy, persistent embryonic blood vessels, vitreous hemorrhage, congenital cataract, etc. Most of them are preventable and controllable, however, many diseases have strict requirements for the effective treatment time window. The basic form and path to carry out the prevention and control of blinding eye diseases in infants and young children are building a prevention and control system with a combination of multi-party medical forces, referral to pediatric eye disease institutions with relevant technical resources for further diagnosis and treatment, so as to achieve early detection, standardized treatment and visual training.
Objective To observe the factors influencing for results of laser treatment of zone one retinopathy of premature（ROP）. Methods The clinical data of 35 patients（69 eyes）with ROP in zone one who diagnosed by examination of indirect ophthalmoscopy were retrospectively analyzed. The eyes were divided into anterior zone one（49 eyes ）and posterior zone one（20 eyes）. The 69 eyes, aggressive posterior ROP（AP-ROP）in 12 eyes, anterior zone one in four eyes and posterior zone one in eight eyes. The laser photocoagulation of diode indirect ophthalmoscopy with +20 D lens and sclera compressor were used to entire avascular retina. Followup ranged from two to 48 months with the mean of (10.85plusmn;11.35 )months. Take the cristae fadeaway and stable condition as cure; retinopathy proceed to the stage 4 and 5 ROP as retinopathy progress. Results Forty-two out of 69 eyes (60.87%) were cured and retinopathy progress in 27 eyes (39.13%). Thirty-four out of 49 eyes (69.38%) with anterior zone one were cured and retinopathy progress in 15 eyes (30.61%); eight out of 20 eyes (40.00%) with posterior zone one were cured and retinopathy progress in 12 eyes (60.00%). The difference of progress rate between anterior and posterior zone one was statistically significant（chi;2=5.15, P＜0.05).Conclusions Laser photocoagulation is effective for treatment of zone one ROP, the prognosis of anterior zone one is better than posterior zone one; retinopathy progress after photocoagulation was associated with extent of fibrovascular organization.
ObjectiveTo observe the curative effect, survival rate, enucleation rate and pathological characteristics of retinoblastoma (RB) in children.MethodsRetrospective clinical study. From March 1999 to December 2018, a total of 313 patients (445 eyes) with RB diagnosed in Ophthalmology Department of Peking University People’s Hospital were enrolled in the study. Among them, 175 were male (55.9%), 138 were female (44.1%); 181 were monocular and 132 were binocular. The international standard of intraocular RB staging (IIRC) was 6, 13, 6, 52, 227 and 9 patients of A, B, C, D, E and extraocular stages respectively. Among the 313 patients, 245 patients were confirmed to the survivance, of which 22 cases (9.0%, 22/245) died. Among 445 eyes, 330 eyes definitely whether or not were enucleated; 184 eyes had definite IIRC stage, eye examination results, definite treatment plan and times before enucleation and definite pathological tumor node metastasis stage after operation. The basic information, demographic characteristics, clinical information, enucleation and treatment plan, pathological and immunohistochemical results were recorded. Binary logistic regression was used to analyze the risk factors of high risk pathological features (HRF) and prognosis in patients with RB.ResultsFrom 1999 to 2018, the survival rate of 245 patients was increased from 82.6% to 96.3% year by year; the enucleation rate of 330 eyes with final enucleation was reduced from 68.8% to 58.3% year by year. The rate of enucleation in stage D and stage E decreased from 83.3% and 100% before 2005 to 37.5% and 85.4% after 2014, respectively. Monocular disease (β=－1.551, P=0.005), stage D, stage E and extraocular stage in IIRC stage (P＜0.005) were the independent risk factors of RB enucleation, while the protective factors were Interventional chemotherapy of ophthalmic artery (IAC) (β=－0.877, P＜0.001). HRF was found in 51 eyes (27.7%). Age of onset (β=0.019, P=0.016) and glaucoma (β=0.816, P=0.050) were independent risk factors for HRF in RB pathology, while IAC treatment was the protective factor for enucleation (β=21.432, P＜0.001).ConclusionsAfter comprehensive treatment, the general trend of RB enucleation rate is gradually decreasing. IAC treatment can reduce the enucleation rate of stage D and E. The older age of onset and glaucoma stage are the independent risk factors of HRF, and IAC can reduce the risk factors of HRF.
Objective To evaluate the therapeutic effects of treatments of eye-retaining and enucleation for choroidal melanomas. Methods The clinical data of 44 patients (44 eyes) with choroidal melanomas after eye-retaining treatments and enucleation surgery were retrospectively analyzed. The metastasis, retention rate of eyeball after eye-retaining treatment, and visual acuity prognosis were observed and analyzed. In 44 eyes treated by eye-retaining therapy, transpupillary thermotherapy (TTT) was performed primaryly on 7 (15.9%), 106 Ru brachytherapy on 25 (56.8%), and local resection of tumor combined with 106 Ru brachytherapy on 12 (27.3%).The average follow-up period was 13.3 months. Results Forty-four patients had no melanoma metastasis during the follow-up period. In 39 patients (88.6%) who had their eyes retained successfully, the retention rate of eyeball was 100%, 92.9%, and 83.3% in 6, 14, and 24 eyes with small, middle, and large tumor, respectively. In the patients treated by eye-retaining therapy, the visual acuity was ge;0.3 in 11 (28.2%), ge;0.05-＜0.3 in 18 (46.2%), and ＜0.05 (25.6%) in 10 eyes. Conclusions 106 Ru brachytherapy and transpupillary thermotherapy are effective treatments for small and medium-sized choroidal melanomas; some selected cases with large choroidal melanomas was treated with local resection of tumor combined with106 Rubrachytherapy. However, longer followup will be necessary to assess if this treatment has a better comprehensive outcome, compared with enucleation surgery. (Chin J Ocul Fundus Dis, 2006, 22: 150-153)