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A Mataftsi, A Balmer, M Nenadov-Beck, L Zografos, FL Munier; Visual Prognosis After Successful Treatment of Retinoblastoma With Chemotherapy and Local Modalities Without Radiation . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4503.
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Purpose: To describe the visual outcome in a series of macular and extramacular retinoblastoma (RB) cases after successful chemotherapy and local treatment. Methods: Visual acuity was investigated in a consecutive series of retinoblastoma patients from a single institution diagnosed between November 1995 and May 1999. Inclusion criteria were as follows: a) all patients treated by chemotherapy and local modalities (thermochemotherapy, thermotherapy, laser photocoagulation and cryocoagulation), b) disease-free interval of at least 18 months after last treatment. Exclusion criteria were: a) conservative treatment requiring external beam radiotherapy, b) conservative treatment by focal modalities only. Results: A total of 15 patients (17 eyes) were included in this study. Among them, 14 were bilaterally affected, of whom 12 had one eye enucleated. Mean number of chemotherapy cycles (including thermochemotherapy) was 3.8 (range 1-7). The mean follow-up was 51.2 months (range 28-71). The tumor staging at presentation ranged from Ib to IV (Reese-Ellsworth classification), or A to C (ABC classification). Visual acuity varied between 2/10 and 10/10 in 5 single eye patients with macular involvement, without nystagmus in 4 of them. In 7 eyes with tumor-free macula, visual acuity ranged from 9/10 to 10/10. Finally, organic amblyopia (<1/10) was documented both in a bilateral case with macular involvement in one eye (9/10 in the fellow eye), and in a unilateral case with macular RB. Conclusion: The present data document for the first time the visual outcome in a series of patients treated with chemotherapy and adjuvant local treatment. This study shows that visual prognosis after such a treatment seems to be at least as good as the one following external beam radiotherapy. Altogether our data suggest that the retinal chemo-induced macular toxicity is below clinical detection, as opposed to actinic maculopathy. In addition, the visual potential of monophthalmic patients with macular involvement is far better than one can predict given the extent of the macular damage.
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