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R. Sivaraj, R. Nair, S. Turner, H. Jenkinson, J. Ainsworth, H. Willshaw; New Mechanism of Retinal Detachment in Retinoblastoma Patients . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2816.
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Retinal detachment is a known association of retinoblastoma with the exudative type often being apparent at the time of presentation and rhegmatogenous detachments developing in patients who have undergone succesful systemic and/or focal therapy. Retinal detachment developing acutely as a result of a brisk therapeutic response to chemotherapy alone has not previously been described. We would like to report a new mechanism of retinal detachment in patients with retinoblastoma who are undergoing chemotherapy.
Illustrative case report of two patients diagnosed with retinoblastoma. There were no associated retinal detachments observed in these patients on presentation. They underwent chemotherapy with carboplatin, vincristine and etoposide as their initial treatment. The treatment was extremely successful in inducing a rapid reduction on the size of tumors in these patients. The clinical picture was however complicated by the occurrence of rhegmatogenous retinal detachments resulting in poor visual outcome.
A large number of retinoblastoma patients present with exudative retinal detachment at the time of presentation which usually settles with chemoreduction. However we have observed the development of retinal detachment in two children who had a rapid shrinking response to chemotherapy which appears to have triggered the development of the detachment. We speculate on the mechanism of these rare acute retinal detachments.
In the present era of successful treatment of retinoblastoma with combined therapeutic modalities, we are increasingly striving for maximum visual rehabilitation of the patients. The observation of retinal detachment following rapid chemoreduction would have implications in long term visual rehabilitation in this group of patients.
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