Ocular and orbital complications following the treatment of retinoblastoma

Purpose. To investigate the ocular and orbital complications observed in ch ildren treated for retinoblastoma. Subjects and methods. We retrospectively studied 73 children (39 boys, 34 g irls) suffering from retinoblastoma. Thirty-six had bilateral tumor and 37 unilateral disease for a total of 109 eyes affected. The follow-up was 6-18 0 months (median 36 months). Enucleation was the most common initial treatm ent approach in the unilateral group, and radiotherapy (by external beam) w as the most common initial therapy in the bilateral group. Cryotherapy, pho tocoagulation, brachytherapy and/or systemic chemotherapy were used as adju vant treatments when necessary. Ocular complications were recorded at the f ollow-up examinations. Results. Cataract developed in 20% of the irradiated eyes. The mean time fr om irradiation until development of cataract was 28.5 months (6-64 months). Radiation retinopathy developed in 12% and was first detected 11-72 months (mean 37 months) after irradiation therapy. Mild transient keratopathy was observed in all eyes undergoing irradiation, and xerophthalmia in one eye. Complications after enucleation included: marked discharge from the socket (11.0%), extrusion of the implant (9.6%), and contraction of the socket (3 .0%). No complications were observed after cryotherapy or laser photocoagul ation of the tumor. Conclusions. Ocular complications after treating children with retinoblasto ma are common and may seriously affect the quality of life of children surv iving the primary malignancy.