Search

The aim of this work is to evaluate the informativity of the ultrasound (US) in detecting retinoblastoma (RB) and the local invasion of the tumor in children using modern multi-purpose ultrasound scanners.Materials and methods. This study included 108 patients (216 eyes) examined for suspected RB. RB was diagnosed in 91 patients, 60 children had unilateral tumor, 31 – bilateral tumor (122 eyes). In the remaining 17 children (20 eyes damaged), different non-tumor pathology of the eye was revealed. Among 122 eyes affected by RB, 51 were removed with subsequent histological examination. 27 eyes were removed before treatment, 24 – after chemotherapy.Results. In our study the informativity of ultrasound in detecting RB are: sensitivity – 98.4 %, specificity – 96.8 %, accuracy – 97.7 %. Sensitivity, specificity and accuracy in assessing tumor invasion to the anterior segment of the eye are 36.4 %, 95.0 % and 82.4 % respectively, to the vitreous body – 97.7 %, 100 % and 97.9 %, to the optic nerve – 54.5 %, 57.1 % and 54.9 %.Conclusion. US examination using linear transducers of 9–18 MHz is highly informative in detecting RB, however, some indicators of the effectiveness in assessing local invasion are not high enough, due to the technical possibilities of the method. One possible way to improve the informativity – to use deep sedation during US examination.

Tumor lesion of the orbit is found in the clinic of various oncohematological diseases in children. Untimely referral of such patients to an oncologist delays the timing of the necessary treatment, thereby worsening the prognosis of the disease. The literature review presents the features of clinical manifestations of orbital pathology in children at the onset of acute myeloid leukemia, myeloid sarcoma, lymphoma, Langerhans cell and non-Langerhans cell histiocytosis. The article presents our own observations and identifies factors that negatively affect the timely diagnosis of oncohematological diseases in this category of patients.

Introduction. Regional blockades in children in ophthalmology operations are used not only for analgesia in the intra- and postoperative period, but also for the prevention of oculocardial reflex (OCR), postoperative nausea and vomiting (PONV). But there is still no convincing data on the advantages of the methods of retrobulbar blockade (RBB) performed under ultrasound guidance and parabulbar blockade (PBB) performed under ultrasound guidance. Aim. In the present study, we investigated the efficacy and safety of RBB under ultrasound guidance with ropivacaine 0.5 % for the prevention of OCR and postoperative pain, as well as PONV when detected with PBB of ropivacaine 0.5 % under ultrasound guidance upon detection of enucleation of the eyeball. Materials and methods. A prospective randomized arterial study was performed for the period 2016–2022. The study included 110 patients with established inclusion criteria. The patients were divided into two groups: 55 patients who performed a RBB + ultrasound and 55 patients who performed a PBB + ultrasound. Evaluated: the likelihood of the introduction of opioid analgesics, the quality of anesthesia, the duration of the block and the likelihood of complications. Results. There was a decrease in intraoperative diseases in the RBB + ultrasound group, where the average dose of fentanyl was increased by 4.1 ± 1.4 μg/kg, and in the PBB + ultrasound group it was 9.7 ± 1.8 μg/kg (p < 0.05 ). The time to the first frequency of the analgesic in the postoperative period was 6.7 ± 1.8 hours in the PBB + ultrasound group, and 11.7 ± 3.3 hours in the RBB + ultrasound group (p < 0.05). Conclusions. There was a significant difference in analgesic efficacy between RBB + ultrasound and PBB + ultrasound. It was revealed that RBB + ultrasound reduces intraoperative opioid requirements, stable intraoperative hemodynamics and longer postoperative analgesia. Therefore, the use of RBB + ultrasound for enucleation of the eyeball in children with retinoblastoma is the preferred technique.

Introduction. Cryotherapy (CT) is one of the main methods of small retinoblastoma (Rb) treatment and remains the “gold standard” for the treatment of small tumors of pre-equatorial localization, however, the number of studies in the literature on this problem is small, and they are represented only by single studies.Purpose of the study – to evaluate long-term results of CT of Rb.Materials and methods. During the period from 2008 to 2021 CT was performed in 87 children (98 eyes, 169 tumors) with Rb. 49 (56 %) patients were boys, 38 (44 %) were girls. The average age at the time of treatment was 22 months (from 0 to 73 months). Bilateral RB was observed in 70 (80 %) patients, unilateral – in 17 (20 %). In 19 (22 %) cases, CT was performed on a single eye. A total of 169 tumors were treated by CT. Most of the treated tumors (138 foci, 82 %) had pre-equatorial localization (35 tumors – on the mid periphery and 103 tumors – on the far periphery of the fundus). 31 (18 %) tumors located postequatorially. The mean tumor thickness was 1.2 (from 0.4 to 2.9) mm, the mean basal diameter was 2.2 (from 0.9 to 4.9) mm.In the vast majority of cases (n = 78, 87 %), CT was performed with an incision of the conjunctiva and separation of the tenon capsule in the projection of the tumor, then a double application with an exposure of 60 seconds was carried out according to the “classic” technology (“freeze–thaw”). In 13 % of cases (n = 9), CT was performed transconjunctivally without a conjunctival incision. In all cases, carbon dioxide (–78 ºC) was used as a refrigerant.Results. Complete tumor regression after CT was achieved in 63 % of cases (106 tumors), of which in 91 % of cases (96 tumors) – after one CT session, in 8 % (9 tumors) – after 2 sessions, in one (1 %) case– after 4 CT sessions. In 10 % of cases (17 tumors) an incomplete regression was observed and subsequent transpupillary laser thermotherapy was performed. In 27 % of cases (43 tumors), continued tumor growth or recurrence of the tumor was detected, and therefore other methods of local treatment were used (brachytherapy, laser thermotherapy, intra-arterial and intravitreal chemotherapy). As a result of organ-preserving treatment, 90 (92 %) eyes were preserved, 8 (8 %) eyes were enucleated.Complications after CT included vitreous hemorrhage in 3 (3 %) patients, preretinal hemorrhage in 7 (8 %) cases, subretinal hemorrhage in 2 %, local retinal detachment in 2 %, one (1 %) case of retinal tear, and vitreoretinal traction in 2 (2 %) patients. The mean follow-up time after CT was 44 months (from 4 to 121 months).Conclusion. CT still takes an important place in Rb local treatment, especially in the treatment of small tumors of peripheral localization. However, long-term results have shown that one session of CT is often not enough to achieve complete tumor regression and it requires either repeated use of CT or application of other local methods, mostly transpupillary laser thermotherapy. However, the use of CT is especially relevant in the treatment of small tumors of pre-equatorial localization, which are resistant to thermotherapy, especially in cases of a tumor height more than 1 mm and basal diameter more than 2 mm, which are too large and inconvenient for thermotherapy of peripheral Rb.

Relevance. Retinoblastoma (RB) is the most common primary intraocular tumor in children. The incidence of RB ranges from 1:14,000 to 1:20,000 newborns. To date, the survival rates of patients with RB reach almost 100 % with timely and adequate diagnosis. Among childhood oncological diseases, RB accounts for 2.3–4.5 % and 85–90 % among intraocular tumors in children. According to the volume of tumor spread, intra- and extraocular forms of the disease are distinguished. Extraocular RB is the spread of the tumor beyond the eye with invasion of the orbital tissues, as well as the possible involvement of adjacent areas, including intracranial without and with regional and/or remote metastases. The main method of treatment of children with extraocular RB is neoadjuvant chemotherapy (CT) with planning of surgical intervention and adjuvant therapy. High-dose CT (HDCT) with autologous hematopoietic stem cell transplantation (auto-HSCT), it allows to increase relapse-free survival in patients without metastatic lesions of the brain and spinal cord, but with their defeat, the prognosis of survival is extremely unfavorable, the nature of the disease is recurrent with 100 % lethality.Description of the clinical case. We report a case of bilateral RB: OD – with extraocular and intracranial spread of the tumor along the optic nerve with a lesion of the chiasm and a transition to the initial parts of the visual tracts. Secondary glaucoma. OS – with intraocular tumor growth in a 3-year-old child. After neoadjuvant chemotherapy, including intrathecal, a simultaneous two-stage operation was performed in the volume of bone-plastic (temporo-orbito-zygomatic) pterionic craniotomy on the right with prechiasmal resection of the right optic nerve and enucleation of the right eye. In the postoperative period, adjuvant chemotherapy was performed, followed by HDCT with auto-HSCT. Radiation therapy has become the final stage of treatment. Brachytherapy for OS tumor and remote radiotherapy for craniospinal region, right orbit, optic nerve stump with chiasm and pituitary pedicle were successively performed. After 14 months from the beginning of treatment and 5 months after its completion, a leptomeningeal relapse of the disease was detected.Conclusion. Rare observations of RB with damage to the visual tracts do not allow us to sufficiently study the features of the course of the tumor process, as well as to develop a single effective approach to antitumor treatment. Among the causes of mortality in patients with extraocular RB, the main one is metastasis, metastasis in the brain and spinal cord.

The detection of an intraocular embryonic tumor – retinoblastoma (RB) – in children and its differential diagnosis with diseases mimicking RB is an important task of imaging. Considering that the clinical and radiological patterns of RB and the diseases mimicking it may be similar, and the choice of a treatment strategy is carried out without preliminary histological examination, the primary diagnosis is of decisive importance. A comprehensive diagnostic approach for suspected RB provides a timely choice of optimal treatment tactics and improves prognosis. The article presents the most demonstrative own observations. The literature review includes the modern possibilities of non-ionizing radiation diagnostics of RB and diseases mimicking as it.