Purpose
The Retcam II is a wide-field, contact digital fundus imaging system that also allows the performance of intraoperative fluorescein angiography (FA). We propose that Retcam FA can be an indispensible tool in the evaluation of retinoblastoma patients, both to confirm the diagnosis and to define the extent of disease.
Methods
We performed an IRB-approved retrospective case series to evaluate Retcam FA results in eyes with advanced retinoblastoma. All new retinoblastoma patients who have undergone FA in the past 10 years on the Retcam II were identified through a database search. Inclusion criteria included: 1) patients diagnosed with advanced retinoblastoma (Group D or E), studied with early, mid-phase, and late-phase FA photographs, 2) no previous treatment 3) follow-up for at least one year. For the cases meeting inclusion criteria, the FA images were analyzed and a chart review was performed to correlate clinical data with angiographic findings.
Results
A total of 43 eyes with advanced, untreated retinoblastoma evaluated with Retcam FA were identified. For the Group D cases (18 eyes), FA findings included: iris neovascularization (4/18), abnormal retinal vascular dilatation (15/18), small retinal vessel telangiectasia (13/18), late vascular leakage (16/18), retinal vein periphlebitis (9/18), and terminal vascular bulbs (1/18). Among the Group E cases (25 eyes), FA findings included: iris neovascularization (23/25), retinal vascular dilatation (20/25), retinal vessel telangiectasia (14/25), late vascular leakage (20/25), retinal vein periphlebitis (7/25), and terminal vascular bulbs (1/25).
Conclusions
Advanced intraocular retinoblastoma is associated with characteristic retino-vascular findings on Retcam FA. Iris neovascularization, retinal vascular dilatation, and capillary telangiectasia are common findings in these eyes, but terminal vascular bulbs are rare. An important finding was the identification of a distinctive retinal periphlebitis on FA, which correlated with the presence of subretinal fluid produced by the tumor. Characteristic angiographic findings in retinoblastoma may be helpful in correctly classifying an eye with advanced disease and also distinguishing this tumor from other pediatric ocular conditions.
Keywords: 703 retinoblastoma