Management of Retinoblastoma with Vitreous Seeds (Retrospective Study)

Abstract

Rb is the most common primary intraocular malignancy in childhood. There have been many recent advances in the diagnosis and treatment of children with Rb. Vitreous seeding is defined as presence of tumor cells in the vitreous cavity. It may be primary or appears during the treatment course (secondary). It is a challenging problem in management of Rb. The management of Rb with vitreous seeds is difficult and the ophthalmologist often must make difficult decisions regarding the use of various modalities of treatment. The physician must be able to recognize residual tumor seeds or recurrence and select the most appropriate supplementary treatment modality. New treatment modalities are expected to be employed clinically not only for eye preservation but also for good visual prognosis. Several treatment modalities are used to manage intraocular Rb with vitreous seeds; systemic chemotherapy, focal therapy (transpupillary thermotherapy, cryotherapy, laser photocoagulation and brachytherapy), Intra-arterial injection of chemotherapy, intravitreal injection of chemotherapy, subTenon's Carboplatin, EBR and enucleation. However, with the great progress in modalities of treatment of Rb with vitreous seeds, enucleation is still recommended in in many situations where eyes contain large tumors, long standing retinal detachement, neovascular glaucoma, pars plana tumor seeding, anterior chamber involvement and if there is suspicion of invasion of optic nerve, choroid or extra scleral extension.