RETINOBLASTOMA is the most common malignant intraocular tumor in children; it is also one of the most highly curable pediatric solid tumors if detected early. The conventional treatment of retinoblastoma is primary enucleation. Recent research reported a trend toward decreasing frequency of enucleation in the management of retinoblastoma. The trend toward globe-sparing interventions has been largely attributed to earlier diagnosis and recent success with conservative globe-sparing treatment options. Currently, globe-sparing interventions include first-line chemotherapy or chemoreduction, subconjunctival chemotherapy, systemic chemotherapy for metastasis, transpupillary thermotherapy (TIT), chemothermotherapy (CTT), laser photocoagulation, cryotherapy, brachytherapy, and external beam radiotherapy (EBRT). Expanded clinical options currently available have markedly decreased the overall enucleation rate for retinoblastoma CLINICAL SCENARIO: A 10-month old boy is brought to an ophthalmologist because of cats eye reflex in the left eye. The patient had undergone enucleation of his right eye for glaucomatous stage retinoblastoma 6 months earlier. Examination revealed the presence of a solitary retinal mass of about 12 mm in diameter, located nasal to the disc. There was no evidence of vitreous seeding Realizing that this was the only eye of the patient, the ophthalmologist wants to do everything humanly possible to preserve it. He has heard about chemothermotherapy (CTT) but is not sure if this was the best alternative he can offer CLINICAL QUESTION: Among patients with retinoblastoma, is chemoreduction combined with adjuvant treatment effective in preserving the globe and vision? (Author)
EYE ENUCLEATION

Objective: This study reported the demographic profile, clinical presentation, treatment, and outcomes of retinoblastoma (RB) patients seen at Jose R. Reyes Memorial Medical Center (JRRMMC) from January 2011 to December 2020. Methods: This was a single-center, retrospective study. Medical records of patients diagnosed with RB at JRRMMC from January 2011 to December 2020 were reviewed. Descriptive statistics were used to summarize the characteristics of the participants. Results: A total of 31 confirmed RB cases were seen, with almost half residing outside Metro Manila (52%). The median age at diagnosis was 2 years, with a slight male predominance (55%). Majority (81%) of patients had unilateral presentation, with leukocoria as the most common sign (19%) prompting consult. Nearly half (43%) of 37 eyes were diagnosed as Group E using the International Classification of Retinoblastoma (ICRB) system. Majority were in the advanced stage; 57% of eyes underwent enucleation and 29, 3 and 3% of patients required additional treatments such as chemotherapy, laser, and radiotherapy, respectively. RB was confirmed in 20 eyes (54%) through histopathology. Survival outcomes showed that 4 patients (13%) were alive, with either completed or ongoing treatment, and 19 (61%) did not complete prescribed management or were lost to follow-up. There were 8 (26%) known deaths. Conclusion Majority of cases were unilateral and at an advanced stage needing enucleation which may indicate low levels of awareness and screening efforts. Survival rates are difficult to ascertain due to patients abandoning treatment that may be attributed to limited social service support. The study reflects the 10-year data prior to the establishment of a collaborative, multispecialty RB team in the institution and exposes various areas that need to be addressed to improve clinical outcomes.
Retinoblastoma ; Enucleation ; Chemotherapy ; Epidemiology

Objectives: To evaluate the prevalence, etiologies, demographics, and clinical presentation of enucleated pseudoretinoblastoma. Methods: This retrospective study reviewed ocular pathology records of enucleated globes with clinically diagnosed or suspected retinoblastoma submitted to a public university ocular pathology laboratory from 2013 to 2018. Hematoxylin-eosin-stained sections of pseudoretinoblastoma cases were reevaluated, and additional clinical data were taken from hospital charts. Results: Of the 211 enucleated eyes with clinically diagnosed or suspected retinoblastoma, 202 (95.7%) had histologically confirmed retinoblastoma, while 9 (4.3%) had pseudoretinoblastoma. The most common ocular conditions mimicking retinoblastoma were retinal dysplasia (2 eyes) and persistent fetal vasculature (2 eyes). The pseudoretinoblastoma group consisted of 4 females and 5 males, and enucleated were 6 right eyes and 3 left eyes. The mean age at the time of enucleation was 3.65 years, and the mean symptom duration was 17.36 months. Leukocoria, which was noted in 4 patients, was the most frequent initial symptom. No significant difference between the pseudoretinoblastoma group and the retinoblastoma group were found in terms of sex, laterality of the enucleated eye, age at the time of enucleation, and symptom duration. Conclusion In this retrospective review, the prevalence of pseudoretinoblastoma in enucleated globes clinically suspected or diagnosed with retinoblastoma was 4.3%. Persistent fetal vasculature and retinal dysplasia were the most common pseudoretinoblastomas. Clinicians should perform a thorough clinical evaluation and judiciously utilize the available diagnostic means to differentiate retinoblastoma from pseudoretinoblastoma.
eye enucleation ; retinal dysplasia ; retinoblastoma

Objective: Recently, holmium laser enucleation of the prostate (HoLEP) has been established as one method of endoscopic surgery for the treatment of benign prostate hyperplasia (BPH). The purpose of our study was to assess initial clinical experiences with HoLEP at our hospital.;Patients and Methods: A retrospective analysis was conducted of 28 patients with obstructive symptoms due to BPH who underwent HoLEP during the 13 months between February 2004 and March 2005.;Results: The mean age of the patients was 67.4 years (range 59 to 78 years). The mean enucleation tissue weight was 24.3 g (range 2 to 95 g), and the average operation time was 94.1 minutes (range 40 to 268 minutes). The mean duration of postoperative catheterization was 3.4 days (range 1 to 6 days). The mean urine flow rate improved, and each patient's satisfaction for voiding, measured on a 5-point scale, was good. There were no major complications during the operations except one case, which was completed with TUR-P because of uncontrollable bleeding. No patients required transfusions. Long-term complications included five cases of stress incontinence (19%), four of urethral stricture (14%), and three temporary retention, two of which required re-catheterization (10%).;Conclusion: HoLEP can be performed without major intraoperative complications. It is an effective treatment for obstructive symptoms due to BPH. However, there are many postoperative problems that must be resolved, including stress incontinence and urethral stricture because of our lack of experience, with HoLEP.
Enucleation ; Prostatic Hypertrophy, Benign ; Complications Specific to Antepartum or Postpartum ; Lasers ; Holmium

Eye Enucleation ; Humans ; Infant ; Retinal Neoplasms ; surgery ; Retinoblastoma ; surgery ; Vitrectomy

Self-enucleation represents an extreme but fortunately rare form of deliberate self-harm. Case reports of patients who self-enucleate reveal some common features. A case of auto-enucleation in a young schizophrenic patient and a short discussion on deliberate self-harm are presented.
Adult ; Eye Enucleation ; Female ; Hallucinations ; Humans ; Schizophrenia ; complications ; Schizophrenic Psychology ; Self-Injurious Behavior

Purpose: To combine the advantage of porosity and biocompatibility of Biphasic Tricalcium Phosphate implant with Muscle Resection Methodology: Non-randomized, uncontrolled clinical case series Results: No migration or extrusion was observed. With improved muscle resection, socket and prosthesis mobility were noted. (Author)
Human ; Young Adult ; Adolescent ; EYE ENUCLEATION ; PROSTHESIS ; IMPLANTS ; ORBITAL IMPLANTS ; ARTIFICIAL IMPLANTS

Schwannomas rarely present as intraocular tumors and are often misdiagnosed as malignant melanoma. We describe a choroidal schwannoma confirmed by sclerouvectomy. A 30-year-old woman presented with a large nonpigmented intraocular mass of the choroid in the right eye and underwent surgical excision by sclerouvectomy. Histologically, the tumor was composed of a mixture of cellular solid components (Antoni A) and loose myxoid components (Antoni B). The tumor was eventually diagnosed as a schwannoma. Currently available ancillary studies are still of little value in definitively differentiating schwannomas from other choroidal tumors. In the case of atypical findings for a malignant melanoma, a benign neoplasm should be included in the differential diagnosis. This patient avoided enucleation by first having the mass excised. We are unaware of previous reports in which a choroidal schwannoma was diagnosed by surgical excision.
Adult ; Choroid/*pathology ; Choroid Neoplasms/*diagnosis/surgery ; Diagnosis, Differential ; Eye Enucleation/*methods ; Female ; Humans ; Magnetic Resonance Imaging ; Neurilemmoma/*diagnosis/surgery

PURPOSE: Radiotherapy is effective in local treatment for retinoblastoma. However, asymmetric facial hypoplasia after radiation is a serious late effect. This study was performed to investigate the effects of enucleation and chemotherapy with or without radiotherapy in advanced intraocular and intraorbital retinoblastoma. METHODS: Between 1985 October and 2006 December, the records of thirty five patients who were diagnosed as retinoblastoma at Yeungnam University Hospital were reviewed. Advanced intraocular and intraorbital retinoblastoma patients classified as Reese-Ellsworth group III, IV, and V and Grabowski- Abramson class II were selected for the study. RESULTS: Eighteen patients were enrolled in this study. All patients were enucleated and had received chemotherapy. Nine patients received radiotherapy and nine patients didn't receive radiotherapy. Tumor cells were found on resection margin of optic nerve in five of nine patients who received radiotherapy, but none of nine who didn't receive radiotherapy. Chemotherapy included vincristine, adriamycin, cyclophosphamide, VM-26, cisplatin before 2001, and vincristine, etoposide, and carboplatin after 2001. There were no recurrences or metastases in nine patients who didn't receive radiotherapy. But two of nine patients who received radiotherapy had metastases to brain. However, all survivors who received radiotherapy had significant facial asymmetry. CONCLUSION: In advanced intraocular and intraorbital retinoblastoma without tumor cell on resection margin of optic nerve, enucleation and chemotherapy without local radiotherapy appears to be safe for long-term survival. However, in those with tumor cells on resection margin of optic nerve, enucleation and chemotherapy with local radiotherapy seems to be necessary to improve survival.
Brain ; Carboplatin ; Cisplatin ; Cyclophosphamide ; Doxorubicin ; Etoposide ; Eye Enucleation ; Facial Asymmetry ; Humans ; Neoplasm Metastasis ; Optic Nerve ; Recurrence ; Retinoblastoma ; Survivors ; Teniposide ; Vincristine

BACKGROUNDLocal resection is an effective method for treating the uveal melanoma. The aim of this study is to evaluate the survival and clinical outcomes of patients with uveal melanoma treated by local resection or enucleation.

METHODSTotally, 167 consecutive patients with uveal melanoma were recruited for the study, of whom 57 patients were treated with local resection and 110 patients were treated with enucleation. The main outcome was measured by the visual acuity, local recurrence, eye retention, metastases, and melanoma-related mortality.

RESULTSThere were statistically significant differences in the largest basal diameter of the tumor (t = -3.441), the tumor thickness (t = -4.140), the ciliary body infiltration (χ(2) = 8.391), and the duration of follow-up (Z = 3.995) between the two groups (P < 0.05). The univariate survival analysis showed that the method of treatment was not significantly associated with metastases. The Cox proportion hazard analysis showed that the risk factors for metastasis involved the age at the time of diagnosis (RR = 1.752, 95% CI 1.066-2.880, P = 0.027), the largest basal diameter of the tumor (RR = 3.508, 95% CI 1.934-6.336, P = 0.000), and the histological type (RR = 2.444, 95% CI 1.106-5.877, P = 0.046). The 5-year metastases rate was 18.60% for the group with local resection and 27.81% for enucleation (χ(2) = 1.214, P > 0.05); the 5-year melanoma-related mortality was 16.27% for the group with local resection and 25.33% for enucleation (χ(2) = 1.304, P > 0.05). The 5-year local tumor recurrence rate was 29.50% and the 5-year accumulated eye retention rate was 69.00% after local resection. The visual acuity which light perception or better of 60 months after local resection was observed in 25 (92.60%) among persons retaining eye.

CONCLUSIONSThe survival outcomes of the patients with local resection were not worse than that of the patients with enucleation, and local resection could make the patient retain eye and partial visual functions. Hence, local resection may be an effective method for patients with uveal melanoma eligible for operation.

Adult ; Eye Enucleation ; methods ; Female ; Humans ; Male ; Melanoma ; surgery ; Treatment Outcome ; Uveal Neoplasms ; surgery ; Visual Acuity ; physiology