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K Murayama, M Ito, Y Ito, S Yoneya; Clinical Course And Pathological Study After Surgical Treatment For Intraocular Retinoblastoma In A Last Eye Of Elder Person . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4502.
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Purpose:To report a surgical cure of retinoblastoma and visual acuity outcome for seven years in a last eye of elderly person. Methods:A 51-year-old man, whose right eye had enucleated at three years old, presented with a whitish retinal tumor in his left eye. The diameter of tumor was growing slowly during a 4-months observation. We treated the patient with external-beam eye irradiation (40Gy). However, after 1.5 years of treatment the degenerative mass in the retina had begun growing again. In spite of the local treatment with laser and cryotherapy, the tumor did not eliminate completely and grew into the vitreous during additional 7-month local treatments. In order to proceed, the patient was fully informed of all aspects of the procedure, including the nature of the combined chemotherapy and the surgical treatment. Then we treated the patient with the 4-drug regimen of carboplatin, etposide, vincristine, and cyclosporin for 2 monthly cycles and the primary tumor responded well but the vitreous seeding did not disappeared. Consequently, the vitreous seeding cells and the primary tumor mass were removed piecemeal with the vitrector, leaving an area of atrophic choroidal tissue and any additional suspicious lesion was treated with endo-photocoaglation. After surgery the best-corrected visual acuity had been 0.2 during 1.5 years without recurrences. However, small white tissue appeared on the disk and on the peripheral retina. As the tumor had been growing slowly, visual acuity had been decreasing to counting fingers. He had finally agreed to enucleate the eye three years after initial vitrectomy. Results:Histopathological examination showed that retinoblastoma cells spread to a part of choroidal tissue and lamina cribrosa without any malignant cells into cilioretinal vein and the section of the optic nerve. There was no evidence for spilling out of tumor cells to metastasize, neither locally nor to any other remote places in the body. Conclusion:Retinoblastoma developed in an elderly patient was successfully removed without spilling out of tumor cells from eyeball. Nevertheless sequela of retinoblastoma in elderly person has so far been disastrous for the preservation the integrity of the eye, surgical approach should be concidered prudently as an ultimate cure modality.
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