Outcome Of Globe Preservation Therapy In Patients With Bilateral Retinoblastoma At The Kenyatta National Hospital, Kenya

Abstract

Aim The past 60 years have seen an evolution in treatment of retinoblastoma from primary enucleation to attempts to salvage the globe and preserve vision in addition to saving life. The developed countries have reported good success rates. Globe preservation was introduced in KNH as early as the 1980s but started being practiced routinely in 2008. This study set out to determine the outcome of globe preservation in Kenya, KNH, from January 2008 to December 2014. Design A descriptive retrospective case series. Methods Using the ICD 69.2 records of a total of 35 patients diagnosed with bilateral retinoblastoma who underwent globe salvage at KNH between January 2008 to December 2014 were retrieved for the study. Data on demographics, presenting complaints, relevant examination findings, globe preservation modalities employed and globe salvage outcomes was collected. Analysis was done using STATA version 13. Results The mean age at presentation was 16.8 months (SD = 12.2, range 2 - 36 months), median 13 months (IQR 6-24). Mean duration between onset of symptoms to presentation at KNH was 7.2 months (SD = 7.3), median duration of 6 months (IQR 3-10). Out of the 35 salvage eyes 12 (34.3%) were Group A eyes, 11 (31.4%) Group B, 5 (14.3%) Group C and 7 (20.0%) Group D. Twenty patients (57.1%) patients received systemic chemotherapy for intraocular chemoreduction of the tumours in the salvage eye. Only 2(5.7%) patients received sub-tenon carboplatin. The main modes of focal consolidative therapy was laser photocoagulation and thermotherapy and cryotherapy. No patient had EBRT of plaque radiotherapy as it was not available. xiv Seven (20.0%) patients had relapse with a median survival time for tumour to relapse of 6.8 months. Nine patines (25.7%) developed new tumours with a median time to development of new tumours of 6.5 months. Fourteen (40.0%) eyes were salvaged with preservation of vision. Of these 12 (85.7%) were Group A and B eyes. Mean duration to salvage was 7.27 months (SD = 4.62). Six eyes (18.18%) were enucleated with a mean duration to enucleation of 15.7 months (SD = 15.51).Nine (25.7%) got lost to follow up and 3 patients (8.6%) developed metastatic disease and globe salvage was abandoned. Conclusion The main treatment modalities employed at the KNH were laser photocoagulation and cryotherapy complemented with systemic chemotherapy where intraocular chemoreduction was required. Forty percent of eyes were salvaged using the resources available. However our rate was low compared to the developed countries. Tumour relapse occurred in 20% of patients with subretinal seeding being a risk factor. Twenty five percent of patients developed new tumours which was similar to other international studies. Recommendation Efforts should be made towards seeking treatment early, improve patient adherence to follow up and introduction of EBRT, plaque radiotherapy and more advanced treatment for patients with Group C and D eyes. A prospective study is also recommended.