视网膜母细胞瘤患者的经角膜玻璃体切除术

Yicheng K. Bao, Gisella M. Sanchez, Thomas C. Lee, Jesse L. Berry, Aaron Nagiel
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摘要

目前治疗视网膜母细胞瘤的方法有利于挽救眼球,但可能导致玻璃体视网膜病变,需要进行手术治疗。对于视网膜母细胞瘤患者的手术方法存在争议。在此,我们介绍一种避免使用化疗或冷冻疗法的经角膜玻璃体切除术。 我们对洛杉矶儿童医院在 2022 年 11 月至 2023 年 12 月期间连续接受玻璃体切除术的 5 名视网膜母细胞瘤消退时间超过 12 个月(D 组/ct2b)的患者进行了回顾性病历审查。 五名患者因人工晶体纤维化、玻璃体出血、白内障、视网膜脱离和硅油去除等不同适应症接受了8次玻璃体切除术。首次玻璃体切除术的平均年龄为 6.2 岁(范围:2-9 岁);距离上次视网膜母细胞瘤治疗的平均时间为 50.4 个月(范围:20-82 个月)。使用23号或25号套管系统进行径向角膜切口,并使用Versa HD LenZ(Oculus)和RESIGHT(蔡司)进行自上而下的观察。化疗和冷冻疗法均未使用。用 10-0 聚乳酸 910 缝线(Vicryl,Ethicon)将伤口与角膜缘平行缝合,最后用水冲洗,以溶解可能存在的视网膜母细胞瘤细胞。手术目的达到,视力保持稳定,平均随访 7.6 个月(范围:3-12 个月),未发现视网膜母细胞瘤扩散。 这种玻璃体切除术适用于视网膜母细胞瘤消退的眼睛,可使用 Versa HD LenZ 进行自上而下的观察。角膜伤口的径向放置避免了通过葡萄膜道进行缝合,术后水冲洗可溶解视网膜母细胞瘤细胞。这种方法可以避免化疗或冷冻疗法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Transcorneal Vitrectomy in Eyes with Regressed Retinoblastoma
Current treatments for retinoblastoma facilitate globe salvage but can result in vitreoretinal disorders that may require surgery. There is controversy on surgical approaches in eyes with retinoblastoma. Here we describe a transcorneal vitrectomy approach that avoids the use of chemotherapy or cryotherapy. Retrospective chart review was performed on five consecutive patients with regressed retinoblastoma for >12 months (Group D/ct2b) at Children’s Hospital Los Angeles who had vitrectomy between November 2022 and December 2023. Five patients underwent 8 vitrectomies for various indications including IOL fibrosis, vitreous hemorrhage, cataract, retinal detachment, and silicone oil removal. Mean age at first vitrectomy was 6.2 years (range: 2-9 years); mean time from last retinoblastoma treatment was 50.4 months (range: 20-82 months). Radially oriented corneal incisions were made with the 23-gauge or 25-gauge trocar system and the Versa HD LenZ (Oculus) was utilized with the RESIGHT (Zeiss) for top-down visualization. Neither chemotherapy nor cryotherapy were utilized. Wounds were sutured parallel to the limbus with 10-0 polyglactin 910 suture (Vicryl, Ethicon), and a final water rinse was performed to lyse any potential retinoblastoma cells. Surgical objectives were achieved, vision remained stable, and no retinoblastoma spread was noted with a mean follow-up of 7.6 months (range: 3-12 months). This vitrectomy technique for eyes with regressed retinoblastoma permits top-down viewing with the Versa HD LenZ. Radial placement of corneal wounds avoids suturing through the uveal tract, and a postsurgical water rinse lyses any retinoblastoma cells. This approach may obviate the need for chemotherapeutics or cryotherapy.
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