Tedavisi Tamamlanmış Retinoblastom Hastalarının Görme Rehabilitasyonu
Özet
Retinoblastoma (RB) is the most common primary intraocular malignancy of children. In recent years, with new treatment modalities the survival rates of RB patients have increased. In addition, there was observed a significant increase in eye salvage rates. Although the priority is to save the patient's life, the preservation of visual function has come to the fore with the success of treatment in RB patients. Therefore, nowadays visual rehabilitation of RB patients has become important. The aim of the study is to evaluate the visual acuity of RB patients, to determine the factors affecting visual acuity and to investigate the benefit of occlusion therapy in these patients.
56 RB eyes of 47 patients included in the study were analyzed. The best corrected visual acuity according to LogMAR was found to be 1.16±0.89.
Macular involvement has been identified as one of the important factors that negatively affect visual acuity. The mean best corrected visual acuity values were found to be 1.6±0.6 in patients with macular involvement, and 0.8±0.93 in patients without macular involvement. The distance measured between the fovea and the tumor showed a moderate negative correlation with visual acuity. Diffuse chorioretinal atrophy was associated with worse visual acuity (p<0.05).
According to tumor laterality, visual acuity level of unilateral patients was found to be better than bilateral patients (p<0.05).
Tumor localization, regression pattern, and International Classification of Retinoblastoma Classification at the time of diagnosis were found to affect visual acuity (p<0.05). While the temporal location of the tumor adversely affects visual acuity, peripheral and inferior tumors have been shown to have better visual outcomes. From the regression patterns, type II tumor were found to have better visual results than type I tumor. At the time of diagnosis, the visual acuity of the International Retinoblastoma Classification group B tumors was found to be better than group D tumors. No significant correlation was found with tumor number, tumor size and diameter (p>0.05).
The mean central macular thickness of the patients (n=42) who had optical coherence tomography was measured as 270±86 μm. A weak correlation was found between central macular thickness values and visual acuity.
In our study, the effect of treatments that had been applied to the tumor on visual acuity was investigated. There was no correlation between intravenous chemotherapy and intraarterial chemotherapy with visual acuity and MT of RB eyes. A positive correlation was found between intravitreal chemotherapy and visual acuity (p<0.05).
Visual acuity improved in 17 (54.8%) of 31 patients for whom occlusion therapy was recommended. Patching time was found to be 0.5-12 hours, and the mean patching time was 2.1±2.9. The follow-up period was 6-30 months, and the mean follow-up period of the patients was 12 months. A strong correlation was found between the patients' visual acuity, patching time and follow-up time (p<0.05). Analysis of refractive errors revealed ≥3.00 myopia in 14 eyes, ≥3.00 hyperopia in 7 eyes, and ≥2.0 astigmatism in 16 eyes.
Macular involvement, chorioretinal atrophy, and bilateral tumor were found to have a negative effect on visual prognosis. The stage, localization and regression pattern of the tumor were found among the factors affecting the visual prognosis. Of the chemotherapies administered, only intravitreal chemotherapy had a negative effect on visual acuity. It was observed that the visual acuity of RB patients improved with occlusion therapy and correction of the refractive errors. It was concluded that RB patients should be included in the rehabilitation program as soon as possible after diagnosis and tumor stabilization.
