Strabismus management in retinoblastoma survivors

Purpose To report the result of strabismus surgery in eye-salvaged retinoblastoma (Rb) patients. Methods A retrospective case series including 18 patients with Rb and strabismus who underwent strabismus surgery after completing tumor treatment by a single pediatric ophthalmologist. Results A total of 18 patients (10 females and 8 males) were included with a mean age of 13.3 +/- 3.0 (range, 2-39) months at the time tumor presentation and 6.0 +/- 1.5 (range, 4-9) years at the time of strabismus surgery. Ten (56%) patients had unilateral and 8(44%) had bilateral involvement and the most common worse eye tumor's group was D (n = 11), C (n = 4), B (n = 2) and E (n = 1). Macula was involved by the tumors in 12 (67%) patients. The tumors were managed by intravenous chemotherapy (n = 8, 47%), intra-arterial chemotherapy (n = 7, 41%) and both (n = 3, 17%). After complete treatment, the average time to strabismus surgery was 29.9 +/- 20.5 (range, 12-84) months. Except for one, visual acuity was equal or less than 1.0 logMAR (<= 20/200) in the affected eye. Seven (39%) patients had exotropia, 11(61%) had esotropia (P = 0.346) and vertical deviation was found in 8 (48%) cases. The angle of deviation was 42.0 +/- 10.4 (range, 30-60) prism diopter (PD) for esotropic and 35.7 +/- 7.9 (range, 25-50) PD for exotropic patients (P = 0.32) that after surgery significantly decreased to 8.5 +/- 5.3 PD in esotropic cases and 5.9 +/- 6.7 PD in exotropic cases (P < 0.001). The mean follow-up after surgery was 15.2 +/- 2.0 (range, 10-24) months, in which, 3 (17%) patients needed a second surgery. Conclusion Strabismus surgery in treated Rb is safe and results of the surgeries are acceptable and close to the general population. There was not associated with tumor recurrence or metastasis.