Primary endoprosthetics of the orbit with a silicone implant in patients with retinoblastoma

Abstract

Relevance. Currently there are various methods of organ-preserving treatment of retinoblastoma (RB), but nevertheless, eyeball enucleation remains one of the main methods of its treating. After removal of the eyeball, children face cosmetic problems such as anophthalmic syndrome, lag in the growth of orbital bones, as well as psychosocial problems. After the introduction of magnetic resonance imaging into a wide medical practice, children with RB began to undergo primary endoprosthesis of the orbit using porous polytetrafluoroethylene implants or non-porous silicone implants, which proved to be an effective method of cosmetic rehabilitation.The purpose of the study – to present our own experience in the use of primary orbital endoprosthesis in children with RB with the use of a silicone implant.Materials and methods. The study included 29 children (29 eyes) who underwent primary endoprosthesis of the orbit after enucleation for RB using a silicone implant (Plastis-M) wrapped in a dacron mesh. Written consent was received from all patients for the processing of personal data, diagnostic examination and treatment. The median age of patients at the time of enucleation was 32.7 (2–93) months. Silicone implants with a diameter of 16 mm (n = 4, 13.8 %), 17 mm (n = 13, 44.8 %) and 18 mm (n = 12, 41.4 %) were used. In most cases (n = 19, 65.5 %) enucleation was performed due to the inability to use organ–preserving treatment, due to the widespread intraocular tumor process, in 7 (24.1 %) cases enucleation was performed due to tumor progression against the background of ongoing treatment, and in 3 (10.3 %) – due to complications that occurred after treatment, namely subatrophy of the eyeball.Results. A satisfactory cosmetic result and a symmetrical look were achieved in all cases. The difference in the endurance of the prosthetic and paired eyes according to exophthalmometry was up to 2 mm. The thickness of the well-developed musculoskeletal stump was 1.5 (0.84–2.74) mm.Conclusions. A silicone implant wrapped in a dacron mesh endoprosthesis provides a stable and cosmetically satisfactory condition of the musculoskeletal stump in children with RB. Replacement of a silicone implant for cosmetic purposes is possible in children who are under regular dynamic control with complete remission of the tumor.