Transpupillary thermotherapy (TTT) is a specific form of ocular TT using infrared radiation (diode laser). Indocyanine green (ICG) is also used to achieve the optimal phototherapy effect in eyes with minimal pigment. Twenty-one patients with 42 retinoblastomas in 30 eyes were reviewed: 13 male and eight female. Median age was 5.5 months at diagnosis (0.5 to 28 months). Median age at treatment was 11.6 months (3 to 31). Mean tumour basal diameter was 3.5mm and mean thickness was 2.5mm. All tumours were posterior to the equator and 18 were located in the macular area. Mean number of treatments was 2.2 (1-5 sessions). Twenty-four had intermediate to high take-up which was maintained in 19 at the second session. Up-takes reduced at further sessions. Thickness of tumour reduced to a mean of 1.7mm. Tumour control with complete regression was achieved in 33 tumours at a mean follow-up of 46 months (0.9 to 198). Two tumours had minimal regression. Seven recurred. Recurrence and non-response treatment was with cryotherapy or plaque radiotherapy. There was no subretinal or vitreous seeding. Important complications were cataract, iris atrophy, transient retinal haemorrhage, foveal oedema and / or atrophy and optic disc traction or atrophy. Overall tumour control was achieved in 79% with globe salvage in 100% of eyes. There were no enucleations, metastasis or death. The authors conclude ICG enhanced TTT is an effective method and most useful in eyes with blonde fundus and little background pigment.
ICG TTT for retinoblastoma
Reviewed by Fiona Rowe
Indocyanine green-enhanced transpupillary thermotherapy for retinoblastoma: analysis of 42 tumours.
CONTRIBUTOR
Fiona Rowe (Prof)
Institute of Population Health, University of Liverpool, UK.
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