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Adjuvant use of laser in eyes with macular retinoblastoma treated with primary intravenous chemotherapy
  1. Andrew W Stacey1,
  2. Mai Tsukikawa1,
  3. Ido Didi Fabian2,
  4. Sarah Turner3,
  5. Helen Jenkinson3,
  6. Vicky Smith4,
  7. Zishan Naeem4,
  8. Bruce Morland3,
  9. John R Ainsworth3,
  10. M Ashwin Reddy4,5,
  11. Manoj Parulekar3,
  12. Mandeep S Sagoo4,6
  1. 1Department of Ophthalmology, University of Washington, Seattle, Washington, USA
  2. 2Goldschleger Eye Institute, Sheba Medical Center, Tel Aviv, Israel
  3. 3Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
  4. 4Royal London Hospital, London, London, UK
  5. 5Paediatric Ophthalmology, Moorfields Eye Hospital NHS Trust, London, UK
  6. 6NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
  1. Correspondence to Andrew W Stacey, University of Washington, 59608, 325 Ninth Ave, Seattle, WA 98104, USA; awstacey{at}uw.edu

Abstract

Background Adjuvant use of laser with systemic chemotherapy for treatment of retinoblastoma may reduce recurrence rates while also causing local side effects. Information is lacking on the effect of laser on visual outcomes.

Methods A retrospective review of two retinoblastoma centres in the United Kingdom was conducted. Patients were included if there was a macular tumour in at least one eye. Eyes that received chemotherapy alone were compared with eyes that received chemotherapy plus adjuvant laser.

Results A total of 76 patients and 91 eyes were included in the study. Systemic chemotherapy alone was used in 71 eyes while chemotherapy plus laser was used in 20 eyes. Demographic characteristics of both groups were similar. Macular relapse rates were similar between groups: 22/71 (31%) eyes in chemotherapy group and 9/20 (45%) eyes in laser group (p=0.29). There was no increase in vitreous relapses in the laser group (2/20 eyes), compared with the chemotherapy group 10/71 eyes (p=0.99). Survival analysis demonstrated similar time to first relapse between groups. Final visual acuity was equal between groups with 6/15 or better present in 31.1% of eyes in the chemotherapy group and 37.5% of eyes in the laser group (p=0.76). Presence of tumour at the fovea was predictive of final visual acuity, regardless of treatment group.

Conclusion Adjuvant laser in the treatment of retinoblastoma is safe and does not lead to increased rate of vitreous recurrence. Final visual acuity is determined by the presence of tumour at the fovea and not the use of laser.

  • Retina
  • Vision
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Footnotes

  • MP and MSS, joint senior authorship.

  • Contributors MAH, JRA, MS, and MP conceived of the study, treated the patients and provided critical review of the manuscript. BM, ZN, VS, HK and ST treated patients and provided critical review of the manuscript. MT, IDF and AS analysed the data and wrote the manuscript.

  • Funding This project was funded in part by Quality Improvement Development and Innovation Scheme of NHS England. AWS was funded in part by an unrestricted grant from Research to Prevent Blindness to the Department of Ophthalmology at the University of Washington.

  • Competing interests None declared.

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

  • Data availability statement Data are available upon reasonable request.

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