Treatment of retinoblastoma in [151] patients

One hundred and fifty-one patients with 223 retinoblastoma [RB] eyes [unilateral 79 patients] and [bilateral 72 patients] forming 1.9% of all malignant cases [7864], were studied at Radiotherapy and Eye Oncology Unit Ain-Shams University for a period of 7 years [from January 1986 to December 1992]. Treatment consisted of enucleation or subtotal exenteration of those eyes that had severe involvement [109 eyes] and was followed by radiation therapy with or without systemic chemotherapy according to indicated criteria. All patients who underwent non-surgical treatment [114 eyes] received radiotherapy +/- chemotherapy followed by enucleation if there was no response. The survival for stage I and II was 100%, while overall survival rate was 98.2% [mean follow up time in months was 29.69 +/- 12.49 range [12-72]. Vision was retained in 78 eyes [33.4%] of all eyes, in 65 patients [38 bilateral and 27 unilateral presentation]

Various patterns of involvement of the optic disc in retinoblastoma

The optic disc may be variously involved in cases of retinoblastoma at the first discovery or during the follow up after treatment. The differentiation between the various modes of involvement in essential as some of them may be confused with recurrence and the clinician might resort to unnecessary drastic measures like enucleation. Examples of the various pictures are mentioned

Retina and vitreous - ten years experience with retinoblastoma

Experience with the management of retinoblastoma during the last ten years by both local cobalt disc application or external beam irradiation with the cooperation of the radiotherapy department is exhibited. Incidence of the main complications, radiational chorioretinopathy is reffered to

Management of retinoblastoma in infants

The relation of the size of the eye to the size of the orbit infants is different from those of children or adults. This imposes certain difficulties during insertion of Co-60 discs. Retinoblastoma in infants, usually of hereditary type grows relatively quicker and the other unaffected eye should be examined at least every two months

Chorioretinopathy complicating local irradiation of retinoblastoma

Three cases of postradiation retinopathy are reported. The findings are analysed. The exudates which are described are really infarcts of the choroid lobules. Chorioretinopathy is proposed as a better descriptive term and three types are suggested. Diagnosis of the condition is important to spare unnecessary enucleation as the infarcted areas might resemble a recurrence. Preadisposing factors are considered and management is discussed

Papillochoroidopathy

Six cases of a specil clinical picture characterised by a papilledema of a rapid onset accompanied by a marked central loss of vision are reported. In some cases the disc oedema was so marked as to involve the peripapillary region. Treatment with corticosteroids caused a rapid resolution of the papilledema but a peripaillary choroidal atrophy of different extent followed. Livolvement of a posterior blood supply to the disc region and the peripapillary choroid either separately or in a main trunk, in an inflammatory process of the posterior sclera its junction with the optic nerve sheath, is suggested most of the cases were preceded by a fever and two of them were bilateral. The optic head is divided into the region of the lamina cribrosa, prelaminar region and surface layer of the optic disc [Havreh 1969] the three areas are supplied by branches of the postericr ciliary arteries or by their anatomical anastomosis represented by the circle of Zinn of which presence is denied by certain authors [Hayreh 1969] the supplying vessels lie in the fibrous septae of the lamina to form a dense capillary plexus. In the prelaminar region the vessel are centripetal branches from the peripapillary choroid plexus. They are end vessel with regional distribution and might have certain communication with the plexus in the lamina cribrosa. The temporal part this region is much more vascular than nasal part. The blood supply of the prelaminar region is still questioned although is a great probability that it comes from the underlying lamina oriborsa plexus of vessels

Optic disc coloboma, maldevelopment of the lamina cribrosa as an underlying cause

A new classification of the coloboma of the optic disc is given. Various degrees of maldevelopment of the lamina cribrosa is suggested to be the underlying cause of the various clinical pictures. The unusual progress in certain cases of a rather congenital abnormality is explained

Congenital dysplasia of the optic nerve and the retina

A case of dysplasia of the optic disc and retina where there is a rudimentary optic disc together with absence of retinal vascularization, is reported, There is also a translucent mass near the optic disc area. The absence of Bruck's membrane, an important barrier between the choroid and the retina, in vertebrates other than the higher apes and man, allows nutrition of all the layers of the retina by the choroidal circulation. The development of Bruck's membrane hinders to a great extent the nutrition of the inner retinal layers which hence need an additive blood supply. This is probably the underlying factor of development of the retinal circulation by budding of the central retinal arteries from the hyaloid vessels at the level of the inner retinal layers, especially at the time of the relatively high nutritional need due to the high metabolic activity of the developing retina. In the case reported, probably the maldevelopment of the inner layer of the optic cup necessitated no supplementary retinal circulation