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Clinical Sciences
November 1, 2005

Long-term Visual Outcome Following Chemoreduction for Retinoblastoma

Author Affiliations

Author Affiliations: Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University (Drs Demirci, C. L. Shields, and J. A. Shields), and Division of Oncology, The Children’s Hospital of Philadelphia (Dr Meadows), Philadelphia, Pa.

Arch Ophthalmol. 2005;123(11):1525-1530. doi:10.1001/archopht.123.11.1525
Abstract

Objective  To evaluate long-term visual outcome following chemoreduction.

Design  Interventional case series evaluating 54 eyes of 40 children with retinoblastoma successfully treated with chemoreduction, consisting of a combination of intravenous carboplatin, etoposide phosphate, and vincristine sulfate plus focal therapy without external beam radiotherapy or enucleation. All patients were followed up for at least 5 years. Patient and tumor data were analyzed for their effect on the main outcome measures (final visual acuities of 20/40 or better and of 20/200 or better) using univariate and multivariate regression models. Patients who failed chemoreduction were excluded.

Results  There were 4 eyes in Reese-Ellsworth group I, 7 in group II, 3 in group III, 15 in group IV, and 25 in group V. The mean distance from the posterior tumor margin to the optic disc was 2 mm, and from the tumor margin to the foveola it was 3 mm. After a mean follow-up of 68 months, 27 eyes (50%) had a final visual acuity of 20/40 or better, and 36 eyes (67%) had final visual acuity of 20/200 or better. Of 33 eyes with macular tumor, only 8 (24%) had a final visual acuity of 20/40 or better, and 15 (45%) had a final visual acuity of 20/200 or better. Of 21 eyes with extramacular tumor, 19 (90%) had a final visual acuity of 20/40 or better, and all (100%) had a final visual acuity of 20/200 or better.

Conclusion  The clinical factors that predicted visual acuity of 20/40 or better were a tumor margin at least 3 mm from the foveola and optic disc and an absence of subretinal fluid.

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