Surgery (Enucleation) for Retinoblastoma

Surgery is not needed for many retinoblastomas, especially for smaller tumors. However, in some cases, surgery to treat the retinoblastoma may be needed.

Enucleation

Enucleation is the removal of the eyeball and part of the optic nerve from the orbit. It is usually used to treat:

• A large tumor in one eye, when vision is unlikely to be saved
• Blind or painful eyes
• Tumors that involve the nerve that connects to the back of the eye, called the optic nerve
• Tumors that recur after other treatments, when vision is poor or lost

The 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 like bone). It is attached to the muscles that move 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 is 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 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.

Orbital exenteration

This procedure is rare in the United States. It is used when retinoblastoma has spread to the orbit, and the highest acceptable doses of chemotherapy and radiation did not cure the cancer.

This procedure removes the eyeball and optic nerve, as well as the other parts of the eye socket. This includes muscles, fat, and sometimes the eyelids.

Placing a central venous catheter

In cases of retinoblastoma where systemic chemotherapy (into the vein) is recommended, a central venous catheter may be placed. This is a small plastic tube placed into a large vein, usually in the arm or chest, to give chemotherapy drugs and perform blood tests.
To learn more, see Intravenous (IV) Lines and Ports Used in Cancer Treatment.

Possible risks and side effects of surgery

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 or orbital exenteration is the loss of vision in that eye, although most often the vision has 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. Radiation therapy, which is often the other major treatment option in such cases, might cause the same side effect. Using an orbital prosthetic or implant can sometimes lessen this effect. Changes to the face structure after surgery are often more noticeable after orbital exenteration, as more tissue is removed.