1 LASER PHOTOCOAGULATION AS MANAGEMENT OF RETINOBLASTOMA Abstract Introduction The management of retinoblastoma can be complex, and it is impossible to establish firm rules regarding treatment. There are several options available for the treatment of retinoblastoma, and the method selected should depend on the size and extent of the tumor(s), whether there is unilateral or bilateral involvement, and the patient’s systemic status. Lasers have played a central role in the treatment of retinoblastomas since the very start of the laser era. Objectives To review two cases of retinoblastoma treated by photocoagulation therapy Case An one-month old baby boy came with his parent with chief complain white freckle in his right eye. From evaluation under anesthesi (EUA), two intraocular masses on inferolateral quadrant were found, size of two masses were 0,5 DD (disc diameter) and 1 DD. He was diagnosed as intraocular masses ec suspect retinoblastoma grade A OD. Photocoagulation with diode laser (810 nm) was performed. One month after laser therapy, the size of intraocular masses was same as before. A three-month old baby girl came with chief complain white freckle on herleft eye since two weeks ago. Patient was diagnosed as retinoblastoma grade B OD et grade D OS. He had undergone chemotherapy, laser photocoagulation for her right eye, and cryo therapy for her left eye. Five years later intraocular mass in herleft eye progressed, she was diagnosed as retinoblastoma grade B OD et grade D-E OS and suggested to enucleation OS. Enucleation of left eye was performed. Conclusion Photocoagulation can be used as local primary therapy and consolidation treatment following primary systemic chemotherapy to eliminate the tumor cells that were resistant to or were not inactivated by primary therapy. Photocoagulation alone, as local primary therapy, appears to be an appropriate method of management in cases where the tumor is small in diameter.
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LASER PHOTOCOAGULATION AS MANAGEMENT OF RETINOBLASTOMA
AbstractIntroductionThe management of retinoblastoma can be complex, and it is impossible to establish firm rules regarding treatment. There are several options available for the treatment of retinoblastoma, and the method selected should depend on the size and extent of the tumor(s), whether there is unilateral or bilateral involvement, and the patient’s systemic status. Lasers have played a central role in the treatment of retinoblastomas since the very start of the laser era.ObjectivesTo review two cases of retinoblastoma treated by photocoagulation therapyCaseAn one-month old baby boy came with his parent with chief complain white freckle in his right eye. From evaluation under anesthesi (EUA), two intraocular masses on inferolateral quadrant were found, size of two masses were 0,5 DD (disc diameter) and 1 DD. He was diagnosed as intraocular masses ec suspect retinoblastoma grade A OD. Photocoagulation with diode laser (810 nm) was performed. One month after laser therapy, the size of intraocular masses was same as before. A three-month old baby girl came with chief complain white freckle on herleft eye since two weeks ago. Patient was diagnosed as retinoblastoma grade B OD et grade D OS. He had undergone chemotherapy, laser photocoagulation for her right eye, and cryo therapy for her left eye. Five years later intraocular mass in herleft eye progressed, she was diagnosed as retinoblastoma grade B OD et grade D-E OS and suggested to enucleation OS. Enucleation of left eye was performed. ConclusionPhotocoagulation can be used as local primary therapy and consolidation treatment following primary systemic chemotherapy to eliminate the tumor cells that were resistant to or were not inactivated by primary therapy. Photocoagulation alone, as local primary therapy, appears to be an appropriate method of management in cases where the tumor is small in diameter.
I. Introduction
Retinoblastoma is the most common malignant ocular tumor of childhood,
with incidence of 1:14.000-1:20.000 live births. This neuroblastic tumor is
typically diagnosed during the first year of life in familial and bilateral cases and
between ages 1 and 3 in sporadic unilateral cases. The most common initial sign is
leukokoria (white pupil) described as a glow, glint, or cat’s eye appearance. Other
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presentations include vitreous hemorrhage, hyphema, ocular or periocular
inflammation, glaucoma, proptosis, and pseudohypopion.1,2
The first goal of retinoblastoma must be preservation of life, then
preservation of eye, and finally preservation of vision. The management of
intraocular retinoblastoma currently incorporates a combination of different
treatment modalitas, including enucleation, chemotherapy, photocoagulation,
cryotherapy, external beam radiation therapy, and plaque brachiotherapy.
Photocoagulation therapy using xenon arc and argon laser (532 nm) or diode laser
(810 nm) have been used to treat retinoblastoma smaller than 3 mm in apical
height with asal dimensional less than 10 mm. Over the years, the result were
comparable between the various types of laser, and a tumor control rate of
approximately 80% was achieved. The currently popular diode laser, used with an
adjustable, indirect opthalmoscope, is far easier to use than the xenon arc
photocoagulator, and moreover has a more favorable absorption range within the
eye than the argon laser.1,3
This study reports a case series of retinoblastoma which treated with
photocoagulation laser therapy in vitreoretinal department of Cicendo Eye
Hospital.
I. Case Report
II.1 Case I
An one-month old baby boy, baby K, came with his parental to vitreoretina
department of Cicendo Eye Hospital. His parents complain about white freckle in
their son’s right eye. Patient was born in the hospital normally through vaginal
birth on 37 weeks of gestation, his birth weight was 3100 grams. There was no
history of illness during pregnancy. He was born from a G1P1A0 mother. On one
month old, his weight was 5330 grams.
From ophthalmological examination, visual acuity was blink reflex for both
eyes. Anterior segment examination was within normal limit. Funduscopy
examination of right eye revealed clear media, round papil, clear border, c/d ratio
0,3-0,4, a/v ratio 2:3, flat retina, fovea reflex (+), two intraocular masses on
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inferolateral quadrant, their size were 0,5 DD (disc diameter) and 1 DD.
Funduscopy examination of left eye was within normal limit, optic disc drusen
(+).
This baby boy was diagnosed multiple intraocular masses e.c susp
retinoblastoma grade A OD + optic disc drusen OS. This patient was consulted to
pediatric ophthalmology unit to undergo retcam examination and his condition
was informed to his parent. The following is his first retcam photograph.
Figure 2.1 Retcam photograph of both eyes before laser treatmentSource : Cicendo Eye Hospital
He was suggested to undergo laser treatment for masses on right eye. One
month later, he undergone laser therapy surrounding the masses in general
anesthesia with infrared (810 nm), duration was 0,20 second, power was 300 mW,
amount of laser spot was 313.
One month after laser treatment, he and his parents came to follow up. On
second month old, his body weight was 4000 gram. Anterior segment examination
was within normal limits for both eyes. Funduscopy examination of right eye
revealed two intraocular lesions on inferolateral quadrant, their size were still 0,5