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Vision and visual potential for perifoveal retinoblastoma after optical coherence tomographic-guided sequential laser photocoagulation
  1. Sameh E Soliman1,2,
  2. Cynthia VandenHoven1,
  3. Leslie D Mackeen1,
  4. Brenda L Gallie1,3,4,5
  1. 1 Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
  2. 2 Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
  3. 3 Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  4. 4 Departments of Molecular Genetics and Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  5. 5 Division of Visual Sciences, Toronto Western Research Institute, Toronto, Ontario, Canada
  1. Correspondence to Dr Sameh E Soliman, Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; samehelsayedsoliman{at}yahoo.com

Abstract

Background/aims To assess tumour control, vision and anatomical visual potential in eyes with perifoveal retinoblastoma treated by sequential photocoagulation from the antifoveal tumour edge inwards, avoiding treatment near the fovea. Patients were monitored for tumour control, foveal and perifoveal anatomy at each treatment session by optical coherence tomography (OCT) and treated for amblyopia when the other eye had better vision.

Methods Eyes with perifoveal retinoblastoma treated between 1 January 2011 and 31 May 2017 with laser therapy after chemotherapy for juxtafoveal (fovea clear of tumour but <3000 µm from tumour edge) or foveolar retinoblastoma (tumour underlying fovea) were retrospectively reviewed for tumour control without recurrence, anatomical success (foveal pit preservation and/or restoration with ≥500 µm perifoveal retina free of tumour and scar) and functional success (acceptable (>0.1 decimal) or good (>0.3 decimal) visual acuity (VA)).

Results Twenty-two eyes (14 juxtafoveal, 8 foveolar tumours) of 20 patients (19 bilateral, 1 familial and 11 females) were included. No juxtafoveal tumour had tumour recurrence, and 13/14 patients showed foveal pit preservation with ≥500 µm of perifoveal retina tumour free. Foveolar tumours had significant worse anatomical outcomes: failure to restore foveal pit or perifoveal retina (8/8, p=0.001) and tumour recurrences (5/8, p=0.001). Functional success with acceptable VA was achieved in 12/14 juxtafoveal and 5/8 foveal tumours eyes (p=0.01). Amblyopia therapy data were insufficient to evaluate impact on VA.

Conclusions Anatomical visual potential and functional vision were better in juxtafoveal than foveolar retinoblastoma treated with foveal-sparing laser photocoagulation guided by OCT. The role of amblyopia therapy requires a prospective study.

  • retinoblastoma
  • optical coherence tomography
  • laser
  • cancer

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Footnotes

  • Contributors Concept and design: SES and BLG. Data collection: SES, CV and LDM. Figure construction: SES, CV and LDM. Analysis and interpretation: SES and BLG. Critical review: all authors. Overall responsibility: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This study was approved by research ethics review board, Hospital of Sickkids, Toronto, Ontario, Canada, and follows the Declaration of Helsinki guidelines.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All additional unpublished data from the study can be shared upon request.

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