Clinical analysis of orbital exenteration for orbital retinoblastoma

Abstract

To analyze the reasons of orbital exenteration for orbital retinoblastoma (RB) patients. Retrospective case series study. Clinical records were reviewed retrospectively of 17 orbital RB patients who had undergone exenteration from November 1999 to November 2010 at Armed Police General Hospital. The clinical records included ophthalmic history, process of diagnosis and treatment, symptom and signs, surgical approach, pathological diagnosis and follow-up results. The reasons of orbital exenteration for orbital RB patients according to medical history, process of diagnosis and treatment were analyzed. The average age of patient was 3.2 years old. The ratio of male versus female was 1.1: 1. The common clinical findings were as following: 11 cases of orbital mass, 7 cases of exophthalmos, 6 cases with palpebral edema, 4 cases of conjunctival congestion and edema with conjunctival mass, and 2 cases with orbital pain. Reasons for orbital exenteration were as following: 7 patients who lost the opportunity of the treatment because of concernning about the cost of treatment and poor prognosis and caused worst outcome. Exenteration had to be done eventually. Five cases of orbital recurrence happened after enucleation. Three patients' Rb invaded into orbit after conservative treatment intravenous chemotherapy or radio therapy alone. Two cases were misdiagnosed and mishandled causing rapidly tumor spread into the orbit. The major reasons of orbital exenteration for orbital RB patients lies in the following: giving up treatment from patients, tumor recurrence in the orbit after enucleation, progressing of orbital RB after simple conservative treatment, misdiagnosis and mishandling to let RB invade into orbit rapidly.