Surgery (Enucleation) for Retinoblastoma

Surgery is not needed for many retinoblastomas, especially for smaller tumors.

But if a tumor has grown large before it is found, vision in the eye might have already been lost, with no hope of getting it back. The usual treatment in this case is enucleation, an operation to remove the whole eye, plus part of the optic nerve attached to it.

Enucleation might also be needed if the cancer is not cured using other treatments that were meant to try to save the eye.

This surgery is done while the child is under general anesthesia (in a deep sleep). During the same operation, an orbital implant is usually put in to take the place of the eyeball. The implant is made of silicone or hydroxyapatite (a substance similar to bone). It is attached to the muscles that moved the eye, so it should move the same way as the eye would have.

Your child will probably be able to leave the hospital the same day or the next day.

After several weeks, you can visit an ocularist, who will create an artificial eye for your child. This is a thin shell that fits over the orbital implant and under the eyelids, like a big contact lens. It will match the size and color of the remaining eye. Once it's in place, it will be very hard to tell it apart from the real eye.

When retinoblastoma occurs in both eyes, enucleation of both eyes would result in complete blindness. If neither eye has useful vision because of damage already caused by the cancer, this may be the best way to make sure all of the cancer is gone. But if there is any chance of saving useful vision in one or both eyes, doctors may advise trying other types of treatment first.

Possible risks and side effects

Complications during or right after surgery, such as bleeding, reactions to anesthesia, or infection, are not common, but they can happen.

The most obvious side effect of enucleation is the loss of vision in that eye, although most often the vision has already been lost because of the cancer.

Removing the eye also can affect the future growth of bone and other tissues around the eye socket, which can make the area look somewhat sunken. Using an orbital implant can sometimes lessen this effect. (Radiation therapy, which is often the other major treatment option in such cases, might cause the same side effect.)

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Hurwitz RL, Shields CL, Shields JA, et al. Chapter 27: Retinoblastoma. In: Pizzo PA, Poplack DG, eds. Principles and Practice of Pediatric Oncology. 7th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2016. 

Kaufman PL, Kim J, Berry JL. Retinoblastoma: Treatment and outcome. UpToDate. Accessed www.uptodate.com/contents/retinoblastoma-treatment-and-outcome on September 25, 2018. 

National Cancer Institute. Retinoblastoma Treatment (PDQ®). 2018. Accessed at www.cancer.gov/types/retinoblastoma/hp/retinoblastoma-treatment-pdq on September 25, 2018. 

Rodriguez-Galindo C, Orbach DB, VanderVeen D. Retinoblastoma. Pediatr Clin North Am. 2015;62(1):201-223.

Last Medical Review: December 3, 2018 Last Revised: December 3, 2018

Last Medical Review: December 3, 2018 Last Revised: December 3, 2018

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