Abstract
PurposeTo investigate the current practice of enucleation with or without orbital implant for retinoblastoma in countries across the world.MethodsA digital survey identifying operation techniques and material used for orbital implants after enucleation in patients with retinoblastoma.ResultsWe received a response of 58 surgeons in 32 different countries. A primary artificial implant is routinely inserted by 42 (72.4%) surgeons. Ten (17.2%) surgeons leave the socket empty, three (5.2%) decide per case. Other surgeons insert a dermis fat graft as a standard primary implant (n=1), or fill the socket in a standard secondary procedure (n=2; one uses dermis fat grafts and one artificial implants). The choice for porous implants was more frequent than for non-porous implants: 27 (58.7%) and 15 (32.6%), respectively. Both porous and non-porous implant types are used by 4 (8.7%) surgeons. Twenty-five surgeons (54.3%) insert bare implants, 11 (23.9%) use separate wrappings, eight (17.4%) use implants with prefab wrapping and two insert implants with and without wrapping depending on type of implant. Attachment of the muscles to the wrapping or implant (at various locations) is done by 31 (53.4%) surgeons. Eleven (19.0%) use a myoconjunctival technique, nine (15.5%) suture the muscles to each other and seven (12.1%) do not reattach the muscles. Measures to improve volume are implant exchange at an older age (n=4), the use of Restylane SQ (n=1) and osmotic expanders (n=1). Pegging is done by two surgeons.ConclusionNo (worldwide) consensus exists about the use of material and techniques for enucleation for the treatment of retinoblastoma. Considerations for the use of different techniques are discussed.
Highlights
No consensus exists about the use of material and techniques for enucleation for the treatment of retinoblastoma
Retinoblastoma is a malignant intra-ocular tumor arising from the developing retina in children, mostly between the ages of 0 to 5
Different treatment modalities have been developed and some offer the possibility of eye salvage [1]
Summary
Retinoblastoma is a malignant intra-ocular tumor arising from the developing retina in children, mostly between the ages of 0 to 5. Treatment is primarily focused on saving the child’s life. Different treatment modalities have been developed and some offer the possibility of eye salvage [1]. Enucleation, the complete removal of the eyeball, remains an important treatment modality. It is a safe method regarding survival and feasible in every hospital setting throughout the world. Enucleation may be the oldest surgical procedure in ophthalmology [2]. The basics are still the same, adjustments have been made to reduce postoperative complications and improve cosmetic results
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