Transcorneal Vitrectomy in Eyes with Regressed Retinoblastoma

Abstract

Current treatments for retinoblastoma facilitate globe salvage but can result in vitreoretinal disorders that may require surgery. There is controversy on surgical approaches in eyes with retinoblastoma. Here we describe a transcorneal vitrectomy approach that avoids the use of chemotherapy or cryotherapy. Retrospective chart review was performed on five consecutive patients with regressed retinoblastoma for >12 months (Group D/ct2b) at Children’s Hospital Los Angeles who had vitrectomy between November 2022 and December 2023. Five patients underwent 8 vitrectomies for various indications including IOL fibrosis, vitreous hemorrhage, cataract, retinal detachment, and silicone oil removal. Mean age at first vitrectomy was 6.2 years (range: 2-9 years); mean time from last retinoblastoma treatment was 50.4 months (range: 20-82 months). Radially oriented corneal incisions were made with the 23-gauge or 25-gauge trocar system and the Versa HD LenZ (Oculus) was utilized with the RESIGHT (Zeiss) for top-down visualization. Neither chemotherapy nor cryotherapy were utilized. Wounds were sutured parallel to the limbus with 10-0 polyglactin 910 suture (Vicryl, Ethicon), and a final water rinse was performed to lyse any potential retinoblastoma cells. Surgical objectives were achieved, vision remained stable, and no retinoblastoma spread was noted with a mean follow-up of 7.6 months (range: 3-12 months). This vitrectomy technique for eyes with regressed retinoblastoma permits top-down viewing with the Versa HD LenZ. Radial placement of corneal wounds avoids suturing through the uveal tract, and a postsurgical water rinse lyses any retinoblastoma cells. This approach may obviate the need for chemotherapeutics or cryotherapy.