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V. Schiedler, T.G. Murray, S.R. Dubovy; Snare Technique For Enucleation Of Eyes With Advanced Retinoblastoma . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2812.
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To compare two surgical techniques (snare wire loop and standard enucleation scissors) for enucleation of pediatric eyes with advanced retinoblastoma with regards to optic nerve length obtained, intraoperative adverse events, and histopathologic evaluation of crush artifact at the surgical margin.
A retrospective review was performed for all patients who underwent enucleation for advanced retinoblastoma at the Bascom Palmer Eye Institute by the same surgeon between March 1994 and March 2005. Intraoperative reports were reviewed to obtain fresh optic nerve length measurements and adverse events such as problems with hemostasis or iatrogenic damage to orbital tissues. Ten snare cases and ten scissors cases were randomly selected for qualitative grading of crush artifact by an ocular pathologist in blinded fashion.
Seventy–seven enucleated eyes of 76 patients with stage 5B retinoblastoma (N = 55 snare, 22 scissors) had sufficient data for inclusion in the study. A statistically significant longer mean optic nerve length was obtained with the snare (13.35mm) compared to scissors (11.05mm; p = 0.0045). There were 4 scissor cases of prolonged bleeding requiring thrombin (18.2%) and no cases of prolonged bleeding with the snare (p = 0.0054). Although there were 2 snare cases of inadvertent extraocular muscle damage and none with the scissors, this was not statistically significant, nor did it affect long–term implant motility. There was significantly more crush artifact with the snare than with scissors (p < 0.001) but this did not affect the ability to determine tumor involvement at the surgical margin.
The enucleation snare provides several surgical advantages over enucleation scissors in the small pediatric orbit. Although the technique requires a few modifications to avoid ensnaring unwanted tissues, an experienced surgeon can easily obtain a longer optic nerve length with less bleeding and no detrimental effect on histopathologic examination of the surgical margin. All three advantages are important considerations in the pediatric patient undergoing enucleation for advanced retinoblastoma.
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