Updated on 14/12/2008

Treatments

  1. Conserving treatments
  2. Operative treatments
  3. The prosthesis

The objective of treatments is to cure the child while preserving, as much is possible, the eye and vision.

Eye anatomy
Eye anatomy

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.

Conserving treatments

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 millimeters. Cryotherapy is done under general anesthesia and involves the use of cold temperatures from -76 to -112 degrees Fahrenheit to destroy tumors. Several successive sessions are sometimes needed.

Curietherapy using radioactive discs

This treatment is used to treat tumors no larger than 15 millimeters 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, etc.). 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.

Tumors behind the equator

Thermochemotherapy

Thermochemotherapy is the most widely used conserving treatment used for tumors on the posterior pole measuring up to 12 millimeters 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 millimeters 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.

Go back to top

Operative treatments

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.

Go back to top

The prosthesis

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.

Image of an ocular prosthesis 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.

Go back to top