Intraocular surgery after treatment of retinoblastoma

Objectives: To analyze the results of intraocular surgery in patients treat ed for retinoblastoma and to assess the ocular and systemic outcomes. Design: Retrospective noncomparative case series. Patients: Forty-five consecutive patients who underwent an introcular surge ry after treatment for retinoblastoma. Main outcome Measures: (1) Recurrence of retinoblastoma, (2) need for enucl eation, and (3) systemic metastasis. Overall outcome was defined as favorab le in the absence of any of these measures and unfavorable in the presence of 1 or more. Results: Thirty-four patients (76%) underwent a single procedure of catarac t surgery, a scleral buckling procedure, or pars plana vitrectomy and 11 (2 4%) underwent a combination of 2 or more surgical procedures. In all, 16 pa tients (36%) achieved final visual acuity better than 20/200. Unfavorable o utcomes included recurrence of retinoblastoma in 14 patients (31%), enuclea tion in 16 (36%), and systemic metastasis in 3 (7%). Five patients (20%) wh o underwent cataract surgery, 5 (63%) who underwent a scleral buckling proc edure, and 9 (75%) who underwent pars plana vitrectomy manifested an unfavo rable outcome. The median interval between completion of treatment for reti noblastoma and intraocular surgery was 26 months in patients with a favorab le outcome vs 6 months in those with an unfavorable outcome. Conclusions: Intraocular surgery after treatment for retinoblastoma may be justified in certain exceptional clinical situations. Cataract surgery is s afe and effective in most cases. However, the need for a scleral buckling p rocedure and pars plana vitrectomy may be associated with a higher risk for recurrence of retinoblastoma, enucleation, and systemic metastasis, and a cautious approach is warranted.