Pars plana vitrectomy under melphalan irrigation for recurrent retinal detachment in eyes treated for retinoblastoma: a case report

Abstract

Background Tractional retinal detachment with or without secondary tear is a rare complication reported in less than 0.5% of in eyes treated for retinoblastoma. Pars plana vitrectomy (PPV) in eyes with history of retinoblastoma has been associated with a significant risk for recurrence, extraocular spread, and systemic metastases. We report here the successful management by PPV under melphalan irrigation of 2 children presenting with tractional retinal detachment after retinoblastoma therapy and scleral buckle surgery. Case presentation A 7-year-old girl with a history of bilateral retinoblastoma (group D) presented with light perception best-corrected visual acuity (BCVA) and tractional retinal detachment (RD) in her left eye, 3 years after the last intra-arterial chemotherapy (IAC) injection. Moreover, she had history of left eye rhegmatogenous RD treated by scleral buckle 1 month after the last IAC and cataract surgery 12 months later. PPV associated with retinectomy, laser photocoagulation and silicone oil tamponade was performed. Silicone oil was removed 4 months later. Fifteen months after PPV, BCVA had increased to 20/32 without recurrence of RD and no evidence of tumor activity. A 7-year-old boy with a history of unilateral retinoblastoma (group D) in his left eye presented with rhegmatogenous RD 21 months after the last treatment for retinoblastoma. Scleral buckle surgery was performed, but 3 weeks later the patient presented with tractional RD associated with proliferative vitreo-retinopathy. BCVA was counting fingers. PPV associated with membrane peel, laser photocoagulation and silicone oil tamponade was performed. Silicone oil was removed after 5 months followed by cataract surgery 5 months later. Twenty months after PPV, BCVA was 20/20 and there was no sign of tumor recurrence. Conclusions PPV under melphalan irrigation, with retinectomy, if necessary, and silicone oil tamponade, allows anatomical and functional improvement in eyes with history of retinoblastoma and scleral buckling developing tractional RD.

Current Indications of Secondary Enucleation in Retinoblastoma Management: A Position Paper on Behalf of the European Retinoblastoma Group (EURbG)

“…Noteworthy, both intravitreal [ 74 ] and/or intra-arterial injections [ 75 , 76 ] can be successfully repeated in relapsing cases. In addition to its use for active tumor treatment, intravitreal melphalan has also enabled a more secure management of various complications, necessitating intraocular surgery such as cataract [ 57 ] or tractional retinal detachment [ 77 , 78 , 79 ]. Similarly, the use of intravitreal anti-VEGF injections performed according to the same technique as intravitreal chemotherapy has permitted the eye-preserving management of treatment- or tumor-related neovascular complications, earlier commonly treated with immediate enucleation [ 80 ].…”

Pars plana vitrectomy for vitreoretinal complications in only seeing eyes after treatment for retinoblastoma

“…A similar attempt was reported for vitrectomy for retinal detachment. 11 , 12 Because we did not observe any adverse event after surgery, we thought that melphalan irrigation is probably safe and can be a useful option. However, the efficacy of melphalan irrigation for the prevention of recurrence or tumor reduction is difficult to assess using data from only a small number of cases.…”

The Results of Pars Plana Vitrectomy in the Treatment of Intraocular Retinoblastoma: A Retrospective Study and Literature Review

“…A number of other studies regarding the PPV in RB patients were also reviewed, however, these research articles focused on the management of the ocular complications such as retinal detachment, vitreous hemorrhage, vitreous turbidity, and other conditions after chemotherapy or radiotherapy. 19 – 23 However, based on these studies, the prognosis of the regressed patients under the treatment of PPV appeared to be much better than the patient with uncontrolled tumors. The literatures also summarized some advices to improve the outcome of PPV for RB patients: (1) Retinal tumors should be stabilized for a long enough time before surgery.…”