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The objective of treatments is to cure the child while preserving,
as much is possible, the eye and vision.
The choice between numerous available treatments depends of the type of tumor
(unilateral or bilateral, unifocal or multifocal), its position inside the eye
(near or far away from the macula), tumor volume and age of the child.
Local treatments for retinoblastoma are increasingly effective and these local treatments can be combined.
Tumors in front of the equator
*Cryotherapy
This technique is used on small tumoral lesions under 3 mm. Cryotherapy is done
under general anesthesia and involves the use of cold temperatures -60 à -80
°C to destroy tumors. Several successive sessions are sometimes needed.
*Curietherapy using radioactive discs
This treatment is used to treat tumors no larger than 15 mm in diameter and
is also used if the vitreous body is invaded. During a quick procedure under
general anaesthesia, the surgeon places a small gold disc containing grains
of radioactive iodine on the surface of the eye. The radiation only destroys
the tumor cells and does not damage the skin tissue near by (eye lids, eye orbit
tissue, … ). The eye lids and conjunctiva are oftentimes a bit swollen when
the disc is in place - two or three days depending on the size of the tumor
- and everything goes back to normal once the disc is removed.
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Tumors behind the equator
*Thermochemotherapy
Thermochemotherapy is the most widely used conserving treatment used for tumors
on the posterior pole measuring up to 12 mm in diameter. Chemiotherapy is combined
with heating the tumor with laser.
The anti-cancer molecule (carboplatine) is given interveneously. Approximately
two hours later under general anesthesia the surgeon direct a laser beam on
the tumor lesion for several minutes using an operating microscope. The temperature
of the tumor increases and thus reinforces the effectiveness of the chemotherapy.
Two to four sessions are necessary to cure 70% of cases without any need to
turn to another treatment.
*Photocoagulation
This technique is used to treat small tumors under 2 mm in diameter. This involves
directing an intense straight laser beam on the blood vessels which feed the
tumor leading to its destruction by burning.
This treatment is painless and lasts just a few minutes under general anaesthesia
either as an outpatient, or during a short hospital stay. Two or three successive
treatments may be required.
*External beam radiotherapy
If the previous mentioned treatments fail or in the case of which are large
or have evolved or tumor which have invaded the vitreous body , doctors may
opt for external beam radiotherapy.
Over a four to five week period and on a daily basis the child's eyes are irradiated
for several minutes in order to destroy the tumor cells. Side effects have been
noted including growth damage of the irradiated zone which may be minimal, endocrine
damage, and increase of the risk for developing secondary sarcomas) and the
usage of this technique has therefore been curtailed.
An initial phase of chemotherapy is sometimes useful for making the tumors more
receptive to different available conservation techniques. The cumulative absorbed
dose of chemotherapeutic agents, used alone or in associated with laser treatments,
must also be very weak because this medecine has mutagenic agents which may
increase the spontaneous risk of developing secondary tumors.
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When the tumor is very large and vision has already been
severely damaged and in order that the cancer not spread, the best therapeutic
solution is the ablation of the eye called ''enucleation''.
This solution is proposed in particular to treat unilateral retinoblastomas
because they oftentimes are diagnosed late since children tend to compensate
the sight loss with the healthy eye.
The operation conducted under general anesthesia lasts approximately one
hour. Following the ablation of the eye, the surgeon places a coral graft to
prepare for placing a prosthesis.
Progress and techniques in this field have helped to obtain satisfactory aesthetic
results. When necessary complementary chemotherapy or radiotherapy treatments
may be required following enucleation if the tumor removed reveals a potential
for relapse or the spread of the cancer to other organs.
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In the case of surgery treatment of retinoblastoma the ablation
of the eye, enucleation is carried out. As your ophthalmologist advised you,
an ocular prosthesis is fitted.
The objective is to give your child a normal looking face and to make his/her
eye natural looking.
The surgeon keeps the muscles intact during the operation. The muscles are then
sutured to an implant which replaces the volume of the eyeball. In addition
to maintaining the optical cavity, the volume filled shall also stimulate the
prosthesis to move, thus making the prosthesis less noticeable. A conformer,
a transparent and perforated shell is placed under the eyelid prior to inserting
the prosthesis. Once the contours of the space have stabilised the conformer
is removed and the prosthesis can be inserted.
An ocular prosthesis is a large custom made rigid lense which reproduces
the color of the iris and the white part of the eye. It is made of PMMA, a sort
of plastic or plexiglass matter which is almost completely unbreakable and
is likewise used for some dental prostheses.
An ocularist conceives and fits the prosthesis.
After the consent of an ophthalmologist, the prosthesis can be inserted one
month after surgery.
It is up to the parents to contact and choose an ocularist. These professionals
can be found throughout the country. Your ophthamologist can provide you with
contact names and addresses.
Trials and fittings are simple and painless. No anaesthesia or hospitalisations
are required. Wearing a prosthesis is in itself painless.
In most cases, wearing a good quality ocular prosthesis goes completely unnoticeable.
in certain cases, conjunctiva secretions in contact with the prosthesis may
be abundant especially in the beginning, but require simply rinsing the eye
with saline solution. Only abnormal redness of the conjunctiva and/or swelling
of the eye lids may indicate that there is a pharyngitis infection), in which
case antibiotic drops must be taken 6 times a day over an 8 day period with
an ointment used in the evening. Ocular prostheses are worn during the day and
at night. Manipulating the prosthesis frequently may cause irritation or increased
secretions.
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Retinostop est une association loi 1901. Parution au JO du 1er mars 1995-page 927-n°1745 |
