Pars Plana Vitrectomy for Retinal Detachment or Vitreous Haemorrhage after Retinoblastoma Regression: A 20-Year Single-Centre Experience.
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INTRODUCTION: Intraocular surgery for retinoblastoma has traditionally been performed carefully because of the risk of tumour spread. However, some eyes with proven tumour regression can develop rhegmatogenous retinal detachment or dense vitreous haemorrhage. We report a 20-year single-centre experience with pars plana vitrectomy in eyes previously treated for retinoblastoma. METHODS: We reviewed cases from a single centre in which children with treated retinoblastoma underwent pars plana vitrectomy for retinal detachment or dense non-clearing vitreous haemorrhage between January 2003 and October 2022. Surgery followed a local oncologic safeguard checklist, Q-TRICS, incorporating documented quiescence, trajectory-safe ports, port-site triple freeze-thaw cryotherapy, intravitreal chemotherapy at closure, silicone oil tamponade, and readiness to enucleate if tumour activity was suspected. Early surgeries used 20-23-gauge Accurus systems, whereas later surgeries used 23-25-gauge Constellation platforms, with intravitreal topotecan administered at the time of closure. RESULTS: This study included nine children. On average, they were 67.6 months old at the time of vitrectomy, and the average interval from the last retinoblastoma-directed therapy to retinal detachment or vitreous haemorrhage was 34.3 months. Seven eyes underwent surgery for retinal detachment, and two had dense vitreous haemorrhage. The median follow-up was 3 years. By the last follow-up, eight out of nine eyes had complete retinal reattachment. Three eyes improved their visual acuity by at least 1.0 logMAR, and four eyes reached a final best-corrected visual acuity of 6/60 or better. There were no cases of tumour recurrence, extraocular extension, metastasis, or secondary malignancy during the follow-up. CONCLUSION: Pars plana vitrectomy was associated with high anatomical success in this small, highly selected series of eyes with regressed retinoblastoma, with no observed intraocular recurrence, extraocular extension, metastasis, or secondary malignancy during the available follow-up period. Although functional recovery was limited, it occurred more frequently in the modern micro-incision, closure-time topotecan era. Larger, multicentre studies with standardised follow-up and toxicity monitoring are necessary to define residual oncologic risk further and establish optimal surgical safeguards.