Transcorneal Vitrectomy in Eyes with Regressed Retinoblastoma

Purpose: Current treatments for retinoblastoma facilitate globe salvage but can result in vitreoretinal disorders that may require surgery. There is controversy on surgical approaches in eyes with retinoblastoma. Here we describe a transcorneal vitrectomy approach that avoids the use of chemotherapy or cryotherapy. Methods: Retrospective chart review was performed on five consecutive patients with regressed retinoblastoma for >12 months (Group D/ct2b) at Children’s Hospital Los Angeles who had vitrectomy between November 2022 and December 2023. Results: Five patients underwent 8 vitrectomies for various indications including IOL fibrosis, vitreous hemorrhage, cataract, retinal detachment, and silicone oil removal. Mean age at first vitrectomy was 6.2 years (range: 2-9 years); mean time from last retinoblastoma treatment was 50.4 months (range: 20-82 months). Radially oriented corneal incisions were made with the 23-gauge or 25-gauge trocar system and the Versa HD LenZ (Oculus) was utilized with the RESIGHT (Zeiss) for top-down visualization. Neither chemotherapy nor cryotherapy were utilized. Wounds were sutured parallel to the limbus with 10-0 polyglactin 910 suture (Vicryl, Ethicon), and a final water rinse was performed to lyse any potential retinoblastoma cells. Surgical objectives were achieved, vision remained stable, and no retinoblastoma spread was noted with a mean follow-up of 7.6 months (range: 3-12 months). Conclusions: This vitrectomy technique for eyes with regressed retinoblastoma permits top-down viewing with the Versa HD LenZ. Radial placement of corneal wounds avoids suturing through the uveal tract, and a postsurgical water rinse lyses any retinoblastoma cells. This approach may obviate the need for chemotherapeutics or cryotherapy.