Dr Gigantelli raises an important question about the necessity of obtaining
a long optic nerve specimen during enucleation for the treatment of retinoblastoma.
Long-held dictums should be repeatedly subjected to challenge, and we applaud
Dr Gigantelli for questioning the wisdom of this traditional teaching.
In support of his argument against the need to obtain a long optic nerve
specimen, he provides 3 references that demonstrate no obvious relationship
among length of optic nerve resected and/or extension to the cut margin of
the nerve, risk of metastasis, and survival. He alludes to the limitations
of his own argument when he suggests that the need for a maximal optic nerve
resection "should be guided by prospective outcome studies evaluating modern
treatment alternatives." The studies that he cites each include only a few
patients with optic nerve invasion, making a definitive statement on this
topic difficult. Until the prospective data that Dr Gigantelli suggests is
available, we will remain in favor of attempting to remove all tumor possible
by obtaining a maximum length of optic nerve. Additionally, we do not agree
with his views on adjunctive therapies. Despite being highly effective in
the treatment of retinoblastoma, chemotherapy and external beam radiation
are not without significant complications. Therefore, any reasonable treatment
that could potentially minimize the need for application of these modalities
is highly desirable.
Coats DK, Paysse EA. A Potentially Life-Threatening Adverse Reaction to Verteporfin. Arch Ophthalmol. 2001;119(1):145. doi: