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Thuma TBT, Silverman RF, Francis JH, Abramson DH. Capturing Bilateral Retinoblastoma. J Pediatr Ophthalmol Strabismus 2024:1. [PMID: 38815105 DOI: 10.3928/01913913-20240508-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
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2
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Oke I, Gonzalez E, Elze T, Miller JW, Lorch AC, Hunter DG, Yeh JM, Diller LR, Wu AC. The Association of Race, Ethnicity, and Insurance Status with the Visual Acuity of Retinoblastoma Survivors in the IRIS® Registry. Ophthalmic Epidemiol 2024:1-7. [PMID: 38578693 DOI: 10.1080/09286586.2024.2315075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/20/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE To identify sociodemographic factors associated with the visual outcomes of retinoblastoma survivors. METHODS Retrospective cohort study using a US-based clinical data registry. All individuals < 18 years of age with a history of retinoblastoma in the Intelligent Research in Sight (IRIS®) Registry (1/1/2013-12/31/2020). The primary outcome was visual acuity below the threshold for legal blindness (20/200 or worse) in at least one eye. Multivariable logistic regression was used to evaluate the association between visual outcomes and age, sex, laterality, race, ethnicity, type of insurance, and geographic location. RESULTS This analysis included 1545 children with a history of retinoblastoma. The median length of follow-up was 4.1 years (IQR, 2.2-5.9 years) and the median age at most recent clinical visit was 12 years (IQR, 8-16 years). Retinoblastoma was unilateral in 54% of cases. Poor vision in at least one eye was identified in 78% of all children and poor vision in both eyes in 17% of those with bilateral disease. Poor visual outcomes were associated with unilateral diagnosis (OR, 1.55; 95% CI,1.13-2.12; p = .007), Black race (OR, 2.03; 95% CI, 1.19-3.47; p = .010), Hispanic ethnicity (OR, 1.65; 95% CI, 1.16-2.37; p = .006), and non-private insurance (OR, 1.47; 95% CI, 1.02-2.10; p = .037). CONCLUSIONS Poor visual outcomes appear to be more common among Black, Hispanic, and publicly insured children with a history of retinoblastoma, raising concerns regarding healthcare inequities. Primary care physicians should ensure that young children receive red reflex testing during routine visits and consider retinoblastoma in the differential diagnosis of abnormal eye exams.
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Affiliation(s)
- Isdin Oke
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Efren Gonzalez
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Tobias Elze
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Joan W Miller
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Alice C Lorch
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - David G Hunter
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer M Yeh
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lisa R Diller
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Ann Chen Wu
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA
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3
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Yeager LB, Kassotis A, Frank T, Li CY, Marr BP. A Review of Pediatric Ophthalmic Tumors. Pediatr Rev 2024; 45:119-131. [PMID: 38425168 DOI: 10.1542/pir.2023-006163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Tumors of the eye, orbit, and ocular adnexa can arise in the pediatric population. These entities can be both vision- and life-threatening and may be associated with systemic disease. Given their relative rarity, pediatricians must be aware of these conditions and understand what findings warrant immediate referral to an ophthalmologist for initiation of further testing. We aimed to review these conditions and highlight clinical features to promote awareness and expedite diagnosis. Tumors are subdivided into the following categories for review: anterior tumors of the eyelid and ocular surface, orbital tumors, and intraocular tumors.
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Affiliation(s)
- Lauren B Yeager
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| | - Alexis Kassotis
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| | - Tahvi Frank
- Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
| | - Chloe Y Li
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| | - Brian P Marr
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
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4
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Pi X, Zhang Q, Wang X, Jiang F. Retinoblastoma and polydactyly in a child with 46, XY, 15pstk+ karyotype-A case report and literature review. Mol Genet Genomic Med 2024; 12:e2414. [PMID: 38465842 PMCID: PMC10926652 DOI: 10.1002/mgg3.2414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/08/2024] [Accepted: 02/21/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Retinoblastoma (Rb) is the most common intraocular malignancy in childhood, originating from primitive retinal stem cells or cone precursor cells. It can be triggered by mutations of the RB1 gene or amplification of the MYCN gene. Rb may rarely present with polydactyly. METHODS We conducted karyotype analysis, copy number variation sequencing, and whole-genome sequencing on the infant proband and his family. The clinical course and laboratory results of the proband's infant were documented and collected. We also reviewed the relevant literature. RESULTS A 68-day-old boy presented with preaxial polydactyly and corneal edema. His intraocular pressure (IOP) was 40/19 mmHg, and color Doppler imaging revealed vitreous solid mass-occupying lesions with calcification in the right eye. Ocular CT showed flaky high-density and calcification in the right eye. This was classified as an International Retinoblastoma Staging System group E retinoblastoma with an indication for enucleation. Enucleation and orbital implantation were performed on the child's right eye. Karyotype analysis revealed an abnormal 46, XY, 15pstk+ karyotype, and the mother exhibited diploidy of the short arm of chromosome 15. The Alx-4 development factor, 13q deletion syndrome, and the PAPA2 gene have been reported as potential mechanisms for Rb combined with polydactyly. CONCLUSION We report the case of a baby boy with Rb and polydactyly exhibiting a 46, XY, 15pstk+ Karyotype. We discuss potential genetic factors related to both Rb and polydactyly. Furthermore, there is a need for further exploration into the impact of chromosomal polymorphisms in Rb with polydactyly.
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Affiliation(s)
- Xiaohuan Pi
- Department of OphthalmologyThe Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan UniversityWuhanChina
| | - Qiming Zhang
- Department of OphthalmologyThe Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan UniversityWuhanChina
| | - Xinghua Wang
- Department of Ophthalmology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Fagang Jiang
- Department of Ophthalmology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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5
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Raval V, Singh A. Management of retinoblastoma: are we there yet? CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00028-0. [PMID: 38431272 DOI: 10.1016/j.jcjo.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/21/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024]
Abstract
Since the introduction of intraarterial chemotherapy (IAC) in the last decade, there has been a paradigm shift in the management of retinoblastoma (RB), especially in developed countries. Despite improved globe salvage outcomes with IAC compared with systemic intravenous chemotherapy, IAC has certain limitations, such as poor accessibility and affordability, especially for middle- and low-income countries; the need for expertise; local ocular complications; and possible increased risk of systemic metastasis. This review discusses the important limitations of the current treatment strategy of using IAC, as well as the prospects of new therapeutic targets or routes of drug delivery that may lead to further improvements in the management of RB.
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Affiliation(s)
- Vishal Raval
- The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India
| | - Arun Singh
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio..
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6
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Black AK, Kahn AE, Lamy C, Warman R, Barengo NC. The association between race and age of diagnosis of retinoblastoma in United States children. J AAPOS 2024; 28:103810. [PMID: 38237725 DOI: 10.1016/j.jaapos.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/29/2023] [Accepted: 11/07/2023] [Indexed: 01/29/2024]
Abstract
PURPOSE To explore the associations between race and retinoblastoma diagnosis in United States children. METHODS In this analytical nonconcurrent cohort study, we used 1988-2018 data from the Surveillance, Epidemiology, and End-Results (SEER) database. Children ages 0-17 with retinoblastoma were included (n = 758); those with missing data were excluded (n = 11; final cohort: n = 747). The exposure variable was race (White, Black, Asian/Pacific Islanders, American Indian/Alaska Native), and the outcome variable was diagnosis of retinoblastoma before versus after 2 years of age. Covariates included sex, rural-urban continuum, ethnicity, decade of diagnosis, and laterality of disease. Unadjusted and adjusted logistic regression analyses were performed to calculate odds ratios and 95% confidence intervals. RESULTS No statistically significant association was found between racial/ethnic groups (OR = 0.61-0.99; P = 0.92) and age at diagnosis (OR = 0.86; P = 0.66). Females were more likely to be diagnosed earlier than males (OR = 0.62; 95% CI, 0.44-0.88; P = 0.042). No association was found between urban versus rural subjects (OR = 1.02; 95% CI, 0.60-1.75) or between decades (OR = 0.81; 95% CI, 0.54-1.22 and OR 0.96; 95% CI, 0.62-1.47). CONCLUSIONS We found no statistically significant difference between racial/ethnic groups for diagnosis of children with retinoblastoma after 2 years of age. Future studies could explore why females are more likely than males to be diagnosed before 2 years of age.
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Affiliation(s)
- Alexander K Black
- Florida International University, Herbert Wertheim College of Medicine, Miami, Florida.
| | - Amanda E Kahn
- Florida International University, Herbert Wertheim College of Medicine, Miami, Florida
| | - Chrisnel Lamy
- Florida International University, Herbert Wertheim College of Medicine, Miami, Florida
| | - Roberto Warman
- Florida International University, Herbert Wertheim College of Medicine, Miami, Florida
| | - Noël C Barengo
- Florida International University, Herbert Wertheim College of Medicine, Miami, Florida
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Aldughayfiq B, Ashfaq F, Jhanjhi NZ, Humayun M. Explainable AI for Retinoblastoma Diagnosis: Interpreting Deep Learning Models with LIME and SHAP. Diagnostics (Basel) 2023; 13:diagnostics13111932. [PMID: 37296784 DOI: 10.3390/diagnostics13111932] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Retinoblastoma is a rare and aggressive form of childhood eye cancer that requires prompt diagnosis and treatment to prevent vision loss and even death. Deep learning models have shown promising results in detecting retinoblastoma from fundus images, but their decision-making process is often considered a "black box" that lacks transparency and interpretability. In this project, we explore the use of LIME and SHAP, two popular explainable AI techniques, to generate local and global explanations for a deep learning model based on InceptionV3 architecture trained on retinoblastoma and non-retinoblastoma fundus images. We collected and labeled a dataset of 400 retinoblastoma and 400 non-retinoblastoma images, split it into training, validation, and test sets, and trained the model using transfer learning from the pre-trained InceptionV3 model. We then applied LIME and SHAP to generate explanations for the model's predictions on the validation and test sets. Our results demonstrate that LIME and SHAP can effectively identify the regions and features in the input images that contribute the most to the model's predictions, providing valuable insights into the decision-making process of the deep learning model. In addition, the use of InceptionV3 architecture with spatial attention mechanism achieved high accuracy of 97% on the test set, indicating the potential of combining deep learning and explainable AI for improving retinoblastoma diagnosis and treatment.
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Affiliation(s)
- Bader Aldughayfiq
- Department of Information Systems, College of Computer and Information Sciences, Jouf University, Sakaka 72388, Saudi Arabia
| | - Farzeen Ashfaq
- School of Computer Science, SCS, Taylor's University, Subang Jaya 47500, Malaysia
| | - N Z Jhanjhi
- School of Computer Science, SCS, Taylor's University, Subang Jaya 47500, Malaysia
| | - Mamoona Humayun
- Department of Information Systems, College of Computer and Information Sciences, Jouf University, Sakaka 72388, Saudi Arabia
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8
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Marasligiller SA, Williams BK, Vadivelu S, Correa ZM, Abruzzo TA, Nicola MD, Lane A, Geller JI. Ocular survival after intra-arterial chemotherapy for retinoblastoma improves with accrual of experience and programmatic evolution. Pediatr Blood Cancer 2023; 70:e30071. [PMID: 36349521 PMCID: PMC9790034 DOI: 10.1002/pbc.30071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 08/14/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Intra-arterial chemotherapy (IAC) for the treatment of intraocular retinoblastoma has gained recognition as a method to improve ocular salvage; however, there is a paucity of evidence supporting treatment factors prognosticating ocular survival. METHODS All patients with retinoblastoma treated with IAC at a single institution between December 2008 and December 2019 were evaluated. Patient demographics, tumor classification, prior treatments, procedural data, other non-IAC therapies, adverse reactions, procedural complications, ocular outcomes, and overall survival were assessed via retrospective chart review. Factors suggestive of increased ocular survival were identified via univariate and multivariate analyses. The impact of accrued treatment experience was evaluated by grouping eyes by the respective year, IAC treatment was initiated. RESULTS Forty-nine eyes of 43 patients were treated for retinoblastoma with IAC (256 total procedures). At least grade 3 neutropenia was observed following 19% of IAC procedures. The risk of neutropenia was not statistically different between single or multidrug IAC. Comparing those who received balloon-assisted intra-arterial chemotherapy (bIAC) in more than two-thirds of cycles to those who did not, the risk of arterial access site complications was not statistically different. Multivariate analysis revealed a significantly lower risk of enucleation associated with treatment era in years (hazard ratio [HR] = 0.52-1.00, p < .05) and laser therapies (HR = 0.02-0.60, p < .05). CONCLUSIONS Ocular survival rates in patients treated with IAC for retinoblastoma at our institution have increased over time. Accrued treatment experience and programmatic changes have likely contributed. Larger, prospective series may lead to a better understanding of factors that consistently contribute to better ocular salvage.
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Affiliation(s)
- Stefan A Marasligiller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Basil K Williams
- Ocular Oncology Service, Department of Ophthalmology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Sudhakar Vadivelu
- Department of Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Zelia M Correa
- Ocular Oncology Service, Department of Ophthalmology, University of Cincinnati, Cincinnati, Ohio, USA
- Ocular Oncology Program, Retina Service, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Todd A Abruzzo
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Maura Di Nicola
- Ocular Oncology Service, Department of Ophthalmology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Adam Lane
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James I Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
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9
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Abolhosseini M, Khorrami Z, Safi S, Akbari ME, Moshtaghion SM, Mohammadi SF, Kanavi MR, Karimi S. A joinpoint and age-period-cohort analysis of ocular cancer secular trends in Iran from 2004 to 2016. Sci Rep 2023; 13:1074. [PMID: 36658192 PMCID: PMC9852578 DOI: 10.1038/s41598-022-26349-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/13/2022] [Indexed: 01/21/2023] Open
Abstract
Investigating secular trends of ocular cancer registration in Iran. After acquiring Iranian national population-based cancer registry data, trends of age-standardised incidence rates (ASIR) of ocular cancers and annual percent changes (APC) between 2004 and 2016 were analysed in age groups, gender, topography and morphology types with joinpoint regression analysis. Age, period, and cohort effects on incidence rates were estimated by age-period-cohort model. Geographic distribution of ASIR was assessed using GIS. Overall ASIR of ocular cancers was 16.04/100,000 (95% CI 15.77-16.32). Joinpoint regression analysis showed a significant increase of ASIR between 2004 and 2009 for males (APC = 5.5, 95% CI 0.9-10.2), ages over 50 years (APC = 5.2, 1.2-9.4), skin/canthus/adnexal cancers (APC = 4.2, 0.8-7.7), and carcinomas/adenocarcinomas (APC = 4.3, 0.6-8.1); however, between 2009 and 2016 a declining trend was observed in all investigated variables. ASIR of retinoblastoma was significantly increased (averaged APC = 20.7, 9-33.7) between 2004 and 2016. age-period-cohort analyses showed that incidence rates of ocular cancers significantly increased with aging, time periods, and birth cohort effects (p < 0.001). ASIR varied from 6.7/100,000 to 21.7/100,000 in Iran. Excepting retinoblastoma, all ocular cancer incidence trends were downward over a 13-year period; however, it was increasing between 2004 and 2009 cancer. ASIR was significant aging in Iran.
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Affiliation(s)
- Mohammad Abolhosseini
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, No. 23, Paidarfard St., Pasdaran Ave., Tehran, Iran.,Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, No 23, Paydar fard st, Pasdaran ave, Tehran, Iran
| | - Zahra Khorrami
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, No. 23, Paidarfard St., Pasdaran Ave., Tehran, Iran
| | - Sare Safi
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, No. 23, Paidarfard St., Pasdaran Ave., Tehran, Iran
| | | | - Seyed Mohamadmehdi Moshtaghion
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, No 23, Paydar fard st, Pasdaran ave, Tehran, Iran
| | - Seyed Farzad Mohammadi
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mozhgan Rezaei Kanavi
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, No 23, Paydar fard st, Pasdaran ave, Tehran, Iran.
| | - Saeed Karimi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, No 23, Paydar fard st, Pasdaran ave, Tehran, Iran.
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10
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DeYoung C, Barke MR, Shields CL. Cavitary Retinoblastoma Imaged on Magnetic Resonance Imaging. J Pediatr Ophthalmol Strabismus 2023; 60:e1-e4. [PMID: 36695349 DOI: 10.3928/01913913-20221118-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Cavitary retinoblastoma is a rare subtype, characterized by the presence of translucent cavities within the solid malignancy. A 2-year-old boy with bilateral retinoblastoma was found to have a unique cavitary retinoblastoma with seven cavities, more than previously reported, and large enough to be imaged on magnetic resonance imaging. [J Pediatric Ophthalmol Strabismus. 2023;60(1):e1-e4.].
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11
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Lam M, Suh D. Screening, Diagnosis, and Treatment of Pediatric Ocular Diseases. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121939. [PMID: 36553382 PMCID: PMC9777216 DOI: 10.3390/children9121939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
Vision is an important aspect of a child's quality of life and intellectual, social, and emotional development. Disruptions to vision during infancy and early childhood can cause lifelong vision impairment or blindness. However, early identification and treatment of eye disease can prevent loss of sight and its consequent long-term effects. Therefore, screening guidelines exist to guide physicians in detecting the most common threats to sight in the different stages of infancy and childhood. This review describes common causes of pediatric vision impairment, the recommended screening guidelines for diagnosing them, and current treatment modalities.
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Affiliation(s)
- Matthew Lam
- Creighton University School of Medicine Phoenix Regional Campus, Phoenix, AZ 85012, USA
| | - Donny Suh
- Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA 92697, USA
- Correspondence:
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12
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Farhat W, Yeung V, Kahale F, Parekh M, Cortinas J, Chen L, Ross AE, Ciolino JB. Doxorubicin-Loaded Extracellular Vesicles Enhance Tumor Cell Death in Retinoblastoma. Bioengineering (Basel) 2022; 9:bioengineering9110671. [PMID: 36354582 PMCID: PMC9687263 DOI: 10.3390/bioengineering9110671] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/08/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
Chemotherapy is often used to treat retinoblastoma; however, this treatment method has severe systemic adverse effects and inadequate therapeutic effectiveness. Extracellular vesicles (EVs) are important biological information carriers that mediate local and systemic cell-to-cell communication under healthy and pathological settings. These endogenous vesicles have been identified as important drug delivery vehicles for a variety of therapeutic payloads, including doxorubicin (Dox), with significant benefits over traditional techniques. In this work, EVs were employed as natural drug delivery nanoparticles to load Dox for targeted delivery to retinoblastoma human cell lines (Y-79). Two sub-types of EVs were produced from distinct breast cancer cell lines (4T1 and SKBR3) that express a marker that selectively interacts with retinoblastoma cells and were loaded with Dox, utilizing the cells’ endogenous loading machinery. In vitro, we observed that delivering Dox with both EVs increased cytotoxicity while dramatically lowering the dosage of the drug. Dox-loaded EVs, on the other hand, inhibited cancer cell growth by activating caspase-3/7. Direct interaction of EV membrane moieties with retinoblastoma cell surface receptors resulted in an effective drug delivery to cancer cells. Our findings emphasize the intriguing potential of EVs as optimum methods for delivering Dox to retinoblastoma.
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Affiliation(s)
- Wissam Farhat
- Department of Ophthalmology, Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
- Correspondence: (W.F.); (J.B.C.)
| | - Vincent Yeung
- Department of Ophthalmology, Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
| | - Francesca Kahale
- Department of Ophthalmology, Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
| | - Mohit Parekh
- Department of Ophthalmology, Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
| | - John Cortinas
- Division of Newborn Medicine, Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Lin Chen
- Department of Ophthalmology, Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
- Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
| | - Amy E. Ross
- Department of Ophthalmology, Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
| | - Joseph B. Ciolino
- Department of Ophthalmology, Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
- Correspondence: (W.F.); (J.B.C.)
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13
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Malik AN, Evans JR, Gupta S, Mariotti S, Gordon I, Bowman R, Gilbert C. Universal newborn eye screening: a systematic review of the literature and review of international guidelines. J Glob Health 2022; 12:12003. [PMID: 36269293 PMCID: PMC9586142 DOI: 10.7189/jogh.12.12003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background This systematic review assessed the effectiveness of universal screening for newborn eye abnormalities compared with no screening in improving infant vision and health outcomes. Methods We searched CENTRAL (Cochrane Library), MEDLINE, Embase, Global Health, Global Index Medicus, clinical trials databases, and bibliographies of relevant articles. We included randomized and observational studies of all newborns, regardless of illness or risk factors, that compared universal screening for any eye abnormality by eight weeks of age with no universal screening. Two authors independently selected studies, extracted data, and evaluated the risk of bias. We used GRADE to assess the certainty of evidence. We also reviewed available recommendations on newborn eye screening. Results Fourteen studies were identified but only three compared universal red reflex screening with no screening. Findings suggest that universal red reflex testing in maternity wards (MWs) may increase the number of newborns with congenital cataracts referred for eye care from MWs or well-baby clinics (WBCs) in the first year of life (risk ratio (RR) = 9.83, 95% confidence interval (CI) = 1.36-71.20; low certainty evidence). However, the effect of screening in WBC is uncertain (RR = 6.62, 95% CI = 0.87-50.09). The effect of MW or WBC screening on referral from any health care facility (MWs, WBCs, paediatrician clinic, other) in the first year is uncertain (MW screening: RR = 1.22, 95% CI = 0.63-2.39; WBC screening: RR = 0.97, 95% CI = 0.46-2.05). However, referral or surgery by 6 weeks of age may be higher with universal MW screening (early referral: RR = 4.61, 95% CI = 1.12-19.01; early surgery: RR = 8.23, 95% CI = 1.13-59.80; low certainty evidence). The effect of WBC screening on early referral and surgery is uncertain (early referral: RR = 1.98, 95% CI = 0.43-9.19; early surgery: RR = 3.97, 95% CI = 0.50-31.33; very low certainty evidence). Universal red reflex testing may increase clinical conjunctivitis (OR = 1.22, 95% CI = 1.01-1.47; low certainty evidence) but the effect on confirmed bacterial conjunctivitis is uncertain (OR = 1.20, 95% CI = 0.76-1.90; very low-certainty evidence). Nine guidelines recommended universal newborn eye screening using red reflex testing. Conclusions Evidence supports the role of red reflex testing shortly after birth to increase early identification, referral, and surgery for congenital cataracts.
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Affiliation(s)
- Aeesha Nj Malik
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Jennifer R Evans
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.,Cochrane Eyes and Vision, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Shuchita Gupta
- Department of Maternal, Newborn, Child and Adolescent Health (MCA), World Health Organization, Geneva, Switzerland
| | - Silvio Mariotti
- Department of Noncommunicable Diseases, Eye and Vision Care, World Health Organization, Geneva, Switzerland
| | - Iris Gordon
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.,Cochrane Eyes and Vision, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Richard Bowman
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Clare Gilbert
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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14
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Jabir AR, Zaheer HA, Zaheer MA, Zaheer EA, Birdsong R. Detection and Diagnosis of Retinoblastoma: Can Mobile Devices Be the Next Step Toward Early Intervention? Cureus 2022; 14:e30074. [DOI: 10.7759/cureus.30074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
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15
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Bernard A, Xia SZ, Saleh S, Ndukwe T, Meyer J, Soloway E, Sintayehu M, Ramet BT, Tadegegne B, Nelson C, Demirci H. EyeScreen. OPHTHALMOLOGY SCIENCE 2022; 2:100158. [PMID: 36245758 PMCID: PMC9560653 DOI: 10.1016/j.xops.2022.100158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 11/29/2022]
Abstract
Purpose Early diagnosis and treatment of retinoblastoma are of paramount importance for a positive clinical outcome. The most common sign of retinoblastoma is leukocoria, or white pupil. Effective, easy-to-perform, community-based screening is needed to improve outcomes in lower-income regions. The EyeScreen (developed by Joshua Meyer from the University of Michigan) Android (Google LLC) smartphone application is an important step toward addressing this need. The purpose of this study was to examine the potential of the novel use of low-cost technologies—a cell phone application and machine learning—to identify leukocoria. Design A cell phone application was developed and refined with the feedback from on-site, single-population use in Ethiopia. Application performance was evaluated in this technology validation study. Participants One thousand four hundred fifty-seven participants were recruited from ophthalmology and pediatric clinics in Addis Ababa, Ethiopia. Methods Photographs obtained with inexpensive Android smartphones running the EyeScreen Application were used to train an ImageNet (ResNet) machine learning model and to measure the performance of the app. Eighty percent of the images were used in training the model, and 20% were reserved for testing. Main Outcome Measures Performance of the model was measured in terms of sensitivity, specificity, receiver operating characteristic (ROC) curve, and precision-recall curve. Results Analyses of the participant images resulted in the following at the participant level: sensitivity, 87%; specificity, 73%; area under the ROC curve, 0.93; and area under the precision-recall curve, 0.77. Conclusions EyeScreen has the potential to serve as an effective screening tool in the areas of the world most affected by delayed retinoblastoma diagnosis. The relatively high initial performance of the machine learning model with small training datasets in this early-phase study can serve as a proof of concept for future use of machine learning and artificial intelligence in ophthalmic applications.
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16
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Chandra K, Raval V, Reddy P VA, Kaliki S. Primary Macular Retinoblastoma: Clinical Presentation and Treatment Outcomes. JOURNAL OF VITREORETINAL DISEASES 2022; 6:367-373. [PMID: 37006899 PMCID: PMC9954921 DOI: 10.1177/24741264221107757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To describe the clinical features and treatment outcomes in eyes with primary macular retinoblastoma (RB). Methods: Patients with primary macular RB were analyzed. Results: Of 41 patients (47 eyes), 20 (49%) were boys and 21 (51%) were girls. The mean age at diagnosis was 16 months (range, 1-60 months). The RB was bilateral in 6 patients (15%). At presentation, the macula was completely covered with the tumor in 22 eyes (47%) and partially covered with the fovea spared in 13 eyes (28%) and the fovea involved 12 eyes (25%). Based on the International Classification of Intraocular Retinoblastoma, 25 (53%), 15 (32%), and 7 (15%) of tumors were in Group B, Group C, and Group D, respectively. The tumor had exophytic features in 36 eyes (77%). The mean tumor basal diameter was 10.0 mm and the mean thickness, 5.6 mm. Associated features included subretinal seeds (10 eyes; 21%) and surrounding subretinal fluid (16 eyes; 34%). Forty-three eyes (92%) were treated with intravenous chemotherapy, 2 (4%) with intra-arterial chemotherapy, and 2 (4%) with transpupillary thermotherapy. Local tumor control was achieved in 45 eyes (96%), with 33 eyes (70%) showing a type III regression pattern. Over a mean follow-up of 23 months (range, 3-48 months), the macular tumor recurred in 5 eyes (11%), the globe was salvaged in all eyes with associated foveal atrophy (36 eyes; 77%), and 1 patient (2%) died. Conclusions: Macular RB has a good prognosis for globe salvage while vision salvage might be compromised as a result of associated foveal atrophy.
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Affiliation(s)
- Kiran Chandra
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India
| | - Vishal Raval
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India
| | - Vijay Anand Reddy P
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India
| | - Swathi Kaliki
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India
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17
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Leumas J, Gillon JT, Cohen SG. Reprint of: Diagnosis of retinoblastoma in a young boy with point-of-care ultrasound. Dis Mon 2022; 68:101392. [DOI: 10.1016/j.disamonth.2022.101392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Surgical Antimicrobial Prophylaxis in Patients of Neonatal and Pediatric Age Subjected to Eye Surgery: A RAND/UCLA Appropriateness Method Consensus Study. Antibiotics (Basel) 2022; 11:antibiotics11050561. [PMID: 35625205 PMCID: PMC9137626 DOI: 10.3390/antibiotics11050561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 01/25/2023] Open
Abstract
Ocular surgery encompasses a wide range of procedures, including surgery of the tear ducts, eyelid, cornea and conjunctiva, lens, ocular muscle, and vitreoretinal and iris surgery. Operations are also performed for the removal of tumors, repairs of ocular trauma and, finally, corneal transplantation. Antibiotic prophylaxis for the prevention of surgical site infections (SSIs) in ocular surgery is a complex field in which shared lines of action are absent. In light of the scarcity of shared evidence in the use of ocular antimicrobial prophylaxis for the pediatric population, this consensus document aims to provide clinicians with a series of recommendations on antimicrobial prophylaxis for patients of neonatal and pediatric age undergoing eye surgery. The following scenarios are considered: (1) intraocular surgery; (2) extraocular surgery; (3) ocular trauma; (4) ocular neoplasm; (5) ocular surface transplantations; (6) corneal grafts. This work has been made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies and represents, in our opinion, the most complete and up-to-date collection of recommendations regarding clinical actions in the peri-operative environment in eye surgery. The application of uniform and shared protocols aims to improve surgical practice, through the standardization of procedures, with a consequent reduction of SSIs, also limiting the phenomenon of antimicrobial resistance.
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19
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Grümme L, Biewald E, Reschke M, Fischhuber K, Hanbücken A, Schlüter S, Müller B, Kiefer T, Göricke S, Geismar D, Ryl T, Sirin S, Wieland R, Timmermann B, Lohmann D, Ebinger M, Brecht IB, Schönberger S, Schwab C, Eggert A, Süsskind D, Ritter-Sovinz P, Bechrakis NE, Ketteler P. Comparing efficacy and side effects of two systemic chemotherapy regimens for eye-preserving therapy in children with retinoblastoma. Pediatr Blood Cancer 2022; 69:e29362. [PMID: 34606174 DOI: 10.1002/pbc.29362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/28/2021] [Accepted: 08/28/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Eye-preserving therapy in retinoblastoma comprises systemic chemotherapy, but studies analyzing the efficacy of different chemotherapy regimens are scarce. METHODS The efficacy and side effects of two different eye-preserving chemotherapy regimens containing either vincristine, etoposide, and carboplatin (VEC) or cyclophosphamide, vincristine, etoposide, and carboplatin (CyVEC) were compared in a prospective non-interventional observational study including children diagnosed with retinoblastoma between 2013 and 2019 in Germany and Austria. Event-free eye survival (EFES) and overall eye survival (OES) of all 164 eyes treated with both regimens and risk factors were investigated. RESULTS The EFES after VEC (2-year EFES 72.3%) was higher than after CyVEC (2-year EFES 50.4%) (plogrank < .001). The OES did not differ significantly between the two treatment groups (plogrank = .77; 2-year OES VEC: 82.1% vs. CyVEC: 84.8%). Advanced International Classification of Retinoblastoma (ICRB) group was prognostic for a lower EFES (plogrank < .0001; 2-year EFES ICRB A/B/C 71.3% vs. ICRB D/E 43.0%) and OES (plogrank < .0001; 2-year OES ICRB A/B/C 93.1% vs. ICRB D/E 61.5%). The multivariate analysis showed that age at diagnosis older than 12 months and ICRB A/B/C were associated with better EFES. No second malignancies or ototoxicities were reported after a follow-up of median 3.1 years after diagnosis of retinoblastoma (range 0.1-6.9 years). CONCLUSIONS Despite omitting cyclophosphamide, the EFES was higher after VEC chemotherapy that contains higher doses of carboplatin compared to CyVEC. The major risk factor for enucleation was advanced ICRB tumor grouping. Randomized clinical trials on efficacy and side effects of eye-preserving chemotherapy are required to tailor treatment protocols for retinoblastoma patients.
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Affiliation(s)
- Lea Grümme
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Essen, Germany
| | - Eva Biewald
- Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Madlen Reschke
- Department of Pediatric Hematology and Oncology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Karen Fischhuber
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Anna Hanbücken
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Essen, Germany
| | - Sabrina Schlüter
- Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Bert Müller
- Department of Ophthalmology, Charité Berlin, Berlin, Germany
| | - Tobias Kiefer
- Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Sophia Göricke
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Dirk Geismar
- West German Proton Centre, University Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Tatsiana Ryl
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Essen, Germany
| | - Selma Sirin
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Regina Wieland
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Essen, Germany
| | - Beate Timmermann
- West German Proton Centre, University Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Dietmar Lohmann
- Institute of Human Genetics, University Hospital Essen, University Duisburg Essen, Essen, Germany
| | - Martin Ebinger
- Institute of Human Genetics, University Hospital Essen, University Duisburg Essen, Essen, Germany
| | - Ines B Brecht
- Pediatric Oncology and Hematology, Children's Hospital, Eberhard Karls Universität, Tübingen, Germany
| | - Stefan Schönberger
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Essen, Germany
| | | | - Angelika Eggert
- Department of Pediatric Hematology and Oncology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Daniela Süsskind
- Department of Ophthalmology, Eberhard Karls Universität, Tübingen, Germany
| | | | | | - Petra Ketteler
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Essen, Germany
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20
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Mullen CJR, Barr RD, Franco EL. Timeliness of diagnosis and treatment: the challenge of childhood cancers. Br J Cancer 2021; 125:1612-1620. [PMID: 34471259 PMCID: PMC8651632 DOI: 10.1038/s41416-021-01533-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/04/2021] [Accepted: 08/19/2021] [Indexed: 02/07/2023] Open
Abstract
Cancer represents an important cause of disease-related death in children worldwide. Improved treatment and understanding of the ways in which cancer manifests has allowed for a greater prospect of survival in children of all ages. However, variation in childhood cancer experience exists based on factors at the individual, community and systems levels. Throughout the cancer care continuum these factors may influence the access and timeliness of care a child receives, leading to delays in diagnosis and treatment. The pejorative designation 'delay in diagnosis and treatment' is better characterised as lag time, representing an interval that is thought to influence survival and overall outcome. In recent decades, work has been done to expedite early childhood cancer diagnosis through the creation of screening and education-based programmes. Although systematic cancer screening in children poses risks and fails to achieve the goal of early diagnosis, a case has been made for risk-based surveillance that has been shown to improve outcome and reduce occurrence of advanced stage disease in targeted populations. The components of lag time are examined separately and individually. This review highlights the challenges of early diagnosis in childhood cancers and describes important contributors in the cancer care continuum.
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Affiliation(s)
- Callum J R Mullen
- Division of Cancer Epidemiology, McGill University, Montréal, QC, Canada
| | - Ronald D Barr
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montréal, QC, Canada.
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21
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Toli A, Perente A, Labiris G. Evaluation of the red reflex: An overview for the pediatrician. World J Methodol 2021; 11:263-277. [PMID: 34631483 PMCID: PMC8472546 DOI: 10.5662/wjm.v11.i5.263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/19/2021] [Accepted: 08/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Red reflex test (RRT) is a simple, non-invasive method that can be performed easily by pediatricians during the clinical examination in neonatal period, infancy and childhood. Abnormal reflexes can lead to prompt diagnosis of several ocular disorders, with potentially severe consequences on patient’s vision, cognitive function and even life.
AIM To underline the contribution of pediatricians to early detection of vision and life threatening diseases by using RRT effectively.
METHODS For the present systematic review, PubMed searches were performed using the key words “red reflex and newborn”; “red reflex and neonate”; “red reflex and complications”; “red reflex and necessity”; “red reflex and retinoblastoma”; “red reflex and congenital cataract”; “red reflex and glaucoma”; “red reflex and prematurity”; “red reflex and leukocoria”; “red reflex and blindness”; “red reflex sensitivity and specificity”; “red reflex and differential diagnosis”; “red reflex and guidelines”. The relevant articles were selected without language restrictions. When a full-text publication was not available, their English abstracts were used. In some cases, studies from the reference lists of the selected articles provided useful information. The research took place in September 2020, in the Ophthalmology Department of University Hospital of Alexandroupolis.
RESULTS A total of 45 articles were selected according to the used key words. After reviewing data from these articles, it is supported that red reflex remains an effective tool of undeniable importance for early detection of severe eye conditions, such as cataract, retinoblastoma, retinopathy of prematurity and glaucoma. Although literature reports some limitations of RRT, including a notable percentage of false positive tests, the inability to detect small, peripheral retinoblastomas and the lower sensitivity for posterior segment pathology, it is widely accepted that the benefits from the regular evaluation of the test on public health are significant. Therefore, RRT has been established by international guidelines and should be an essential component of pediatricians clinical practice. Red reflex implementation should be incorporated in pediatricians educational programs, so that they would be able to provide quality services and safe diagnoses.
CONCLUSION The implementation of RRT should be encouraged in all neonatal/pediatric departments. Prompt education of pediatricians should be empowered in order to achieve careful vision screening, according to current guidelines.
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Affiliation(s)
- Aspasia Toli
- Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | - Asli Perente
- Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | - Georgios Labiris
- Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
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22
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Kiernan M, Fabian ID, Smith V, Sagoo MS, Reddy MA. Strabismus as a Presenting Sign in Retinoblastoma. J Pediatr Ophthalmol Strabismus 2021; 58:324-330. [PMID: 34592118 DOI: 10.3928/01913913-20210614-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the presenting signs of retinoblastoma in a large cohort of patients who underwent orthoptic assessment at presentation. METHODS A retrospective medical chart review was conducted on 131 patients with retinoblastoma who presented consecutively to a single institution during a 6-year period. The main outcome measure was the presenting sign(s) of the disease. RESULTS Of 131 patients with retinoblastoma, 88 presented with unilateral disease and 43 presented with bilateral disease (mean ages: 22.7 and 14.8 months, respectively). Leukocoria was the presenting sign in 56% of patients, leukocoria and strabismus in 18%, strabismus in 13%, inflammation in 8%, and "other" signs in 5%. The fovea was affected by the retinoblastoma tumor or its sequelae in 75% of patients. Patients who presented with strabismus were significantly more likely to have foveal involvement than patients who presented with leukocoria alone (P = .001). Thirty-one percent of patients had strabismus as a component of their presentation; 63% had exotropia, 23% had esotropia, and 14% had variable strabismus. The percentage of patients with strabismus increased to 66% when small angle and variable strabismus were also considered. Patients with inflammation had worse ocular survival (P < .05). CONCLUSIONS This study assessed the combination of leukocoria and strabismus as presenting features of retinoblastoma. Foveal involvement is common in patients who have strabismus and may influence decision-making regarding globe salvage. The authors confirmed that exotropia is more common than esotropia in retinoblastoma in the largest cohort to have undergone an orthoptic assessment. [J Pediatr Ophthalmol Strabismus. 2021;58(5):324-330.].
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23
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Gupta A, Menoch M. What's in an Eye? Pediatr Rev 2021; 42:127-131. [PMID: 34470892 DOI: 10.1542/pir.2018-0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Ayush Gupta
- Pediatric Emergency Medicine, Children's Hospital of New Orleans, LA
| | - Margaret Menoch
- Pediatric Emergency Medicine, William Beaumont Hospital, Royal Oak, MI
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24
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Abstract
Retinoblastoma is the most common ocular malignancy of childhood. With an estimated 300 cases annually in the United States, retinoblastoma is nevertheless considered a rare tumor. Although retinoblastoma primarily affects younger children, diagnosis during the neonatal age range is less common. However, an understanding of patients at risk is critical for appropriate screening. Early detection and treatment by a multidisciplinary specialty team maximizes the chance for survival and ocular/vision salvage while minimizing treatment-related toxicity. Testing for alterations in the RB1 gene has become standard practice, and informs screening and genetic counseling recommendations for patients and their families.
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25
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Reynolds MM, Sein J, Hayashi R, Lueder G. Treatment of small and medium retinoblastoma tumors with Iris diode laser. Eur J Ophthalmol 2021; 31:3318-3323. [PMID: 33530736 DOI: 10.1177/1120672121991390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Differing techniques have been reported for focal laser therapy for patients with small and medium retinoblastoma. We report the technique used at our center; and report the functional and anatomical outcomes for small and medium retinoblastomas treated with focal laser therapy with or without systemic chemotherapy. METHODS A retrospective case study was conducted including pediatric patients with macular retinoblastoma treated with systemic chemotherapy and laser ablation from July 1990 to July 2015 at Washington University School of Medicine/Saint Louis Children's Hospital. RESULTS Fourteen eyes (11 patients) with small and medium retinoblastoma tumors were treated with repetitive indirect laser hyperthermia and seven of those patients were treated with systemic chemotherapy as well. Using the International Retinoblastoma classification, one eye was stage A, 10 eyes were stage B, and three eyes were stage C. The mean follow-up time was 7.7 years. There were no recurrences of tumor in the patients. Final visual acuity outcomes were 20/20 to 20/50 in four eyes, 20/60 to 20/200 in four eyes, and 20/400 or less in six eyes. None of the patients developed metastatic disease. CONCLUSIONS The evidence for systemic chemotherapy and diode laser therapy is limited to case series and retrospective reviews, but evidence suggests that it is an effective treatment for small and medium sized retinoblastoma tumors involving the macula with the potential for good visual outcomes.
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Affiliation(s)
- Margaret M Reynolds
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Julia Sein
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Robert Hayashi
- Department of Hematology and Oncology, Saint Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Gregg Lueder
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
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Pruteanu DP, Olteanu DE, Cosnarovici R, Mihut E, Nagy V. Genetic predisposition in pediatric oncology. Med Pharm Rep 2020; 93:323-334. [PMID: 33225257 PMCID: PMC7664724 DOI: 10.15386/mpr-1576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/10/2020] [Accepted: 07/25/2020] [Indexed: 11/23/2022] Open
Abstract
Identifying patients with a genetic predisposition for developing malignant tumors has a significant impact on both the patient and family. Recognition of genetic predisposition, before diagnosing a malignant pathology, may lead to early diagnosis of a neoplasia. Recognition of a genetic predisposition syndrome after the diagnosis of neoplasia can result in a change of treatment plan, a specific follow-up of adverse treatment effects and, of course, a long-term follow-up focusing on the early detection of a second neoplasia. Responsible for genetic syndromes that predispose individuals to malignant pathology are germline mutations. These mutations are present in all cells of conception, they can be inherited or can occur de novo. Several mechanisms of inheritance are described: Mendelian autosomal dominant, Mendelian autosomal recessive, X-linked patterns, constitutional chromosomal abnormality and non-Mendelian inheritance. In the following review we will present the most important genetic syndromes in pediatric oncology.
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Affiliation(s)
- Doina Paula Pruteanu
- Department of Pediatric Oncology, "Prof. Dr. Ion Chiricuta" Oncology Institute, Cluj-Napoca, Romania.,Department of Radiation Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Diana Elena Olteanu
- Department of Pediatric Oncology, "Prof. Dr. Ion Chiricuta" Oncology Institute, Cluj-Napoca, Romania
| | - Rodica Cosnarovici
- Department of Pediatric Oncology, "Prof. Dr. Ion Chiricuta" Oncology Institute, Cluj-Napoca, Romania
| | - Emilia Mihut
- Department of Pediatric Oncology, "Prof. Dr. Ion Chiricuta" Oncology Institute, Cluj-Napoca, Romania
| | - Viorica Nagy
- Department of Pediatric Oncology, "Prof. Dr. Ion Chiricuta" Oncology Institute, Cluj-Napoca, Romania.,Department of Radiation Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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27
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Staffieri SE, Rees G, Sanfilippo PG, Cole S, Mackey DA, Hewitt AW. Improving parents' knowledge of early signs of paediatric eye disease: A double-blind randomized controlled trial. Clin Exp Ophthalmol 2020; 48:1250-1260. [PMID: 33058401 DOI: 10.1111/ceo.13866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/27/2020] [Accepted: 10/02/2020] [Indexed: 01/18/2023]
Abstract
IMPORTANCE Educating parents to recognize signs of eye disease and consult a healthcare professional is critical to timely diagnosis, intervention and outcomes. BACKGROUND We evaluate the effectiveness of an eye-health information pamphlet on parents' level of concern and help-seeking intention should they hypothetically observe leukocoria or strabismus in their child. DESIGN Double-blind, randomized controlled trial conducted at a metropolitan antenatal outpatient clinic. PARTICIPANTS In total, 518 pregnant women were enrolled in the study. METHODS After completing a study-specific, pre-test survey describing hypothetical clinical scenarios at baseline, participants were randomly assigned to receive a pamphlet on either paediatric eye health (intervention) or infant play (control). The post-test survey was sent by email 2 weeks after baseline. MAIN OUTCOME MEASURES A change in the parents' level of concern if they observed leukocoria or strabismus and a change in their help-seeking intention if they hypothetically observed leukocoria or strabismus in their child. RESULTS Of the 518 women, 382 (73.7%) completed the post-test survey. At follow-up, women who received the intervention were more likely to report a higher level of concern if they observed leukocoria (OR 1.711 [CI: 1.176-2.497] P = .005]) and were less likely to delay help-seeking (OR 0.560 [CI 0.382-0.817] P = .003). No change in the level of concern for strabismus was identified between the groups; however, at follow-up, women who received the intervention were less likely to delay help-seeking (OR 0.318 [CI 0.125-0.806] P = .016). CONCLUSION AND RELEVANCE Providing parents with relevant, evidence-based information can significantly improve their knowledge and positively influence help-seeking intentions if leukocoria or strabismus are observed.
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Affiliation(s)
- Sandra E Staffieri
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Ophthalmology, University of Melbourne, Melbourne, Victoria, Australia.,Department of Ophthalmology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Gwyneth Rees
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Paul G Sanfilippo
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Stephen Cole
- Royal Women's Hospital, Parkville, Victoria, Australia
| | - David A Mackey
- Lion's Eye Institute, Centre for Ophthalmology and Visual Sciences, University of Western Australia, Perth, Australia
| | - Alex W Hewitt
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Ophthalmology, University of Melbourne, Melbourne, Victoria, Australia.,Menzies Institute for Medical Research, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Raval V, Bowen RC, Soto H, Singh A. Chemotherapy for Retinoblastoma: Impact of Intravitreal Chemotherapy. Asia Pac J Ophthalmol (Phila) 2020; 10:200-202. [PMID: 32925294 DOI: 10.1097/apo.0000000000000322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Chemotherapy is now the primary treatment of retinoblastoma in eyes with visual potential or those that are considered not advanced for retinoblastoma. In addition to intravenous chemotherapy (IVC), drugs delivered via alternative routes such as intra-arterial and intravitreal administration have emerged as promising options for management of retinoblastoma. Various studies have shown excellent results in salvaging nearly 100% of groups A-C eyes; however, intra-arterial chemotherapy (IAC) seems to offer superior local control rates as compared with IVC for advanced intraocular retinoblastoma (groups D and E eyes). Intravitreal chemotherapy (IVitC), that delivers the highest concentration of drug in the vitreous cavity while minimizing systemic drug concentration, has emerged in recent years (2012) as an effective treatment for refractory or persistent vitreous seeding. The role of concomitant and subsequent therapies is an important consideration, particularly the use of IVitC in combination with IAC. As IVitC became acceptable during the era of IAC, most of the patients treated previously with IVC did not receive IVitC. Therefore, it is possible that some of the IVC failures could have been avoided with the use of IVitC. We provide our perspective of published data that seems to be skewed by evolving practice patterns that project enhanced efficacy of IAC when compared with historic control rates achieved with IVC. In absence of better-quality data or randomized controlled trials, it is hard to establish superiority of one treatment over the other.
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Affiliation(s)
- Vishal Raval
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH
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Yousef YA, Alkhoms A, AlJabari R, AlJboor M, Mohammad M, Lahlouh M, Deebajah R, Halalsheh H, Al-Hussaini M, Jaradat I, Shawagfeh M, Sultan I, Mehyar M, AlNawaiseh I. Programmed screening for retinoblastoma enhances early diagnosis and improves management outcome for high-risk children. Ophthalmic Genet 2020; 41:308-314. [PMID: 32432497 DOI: 10.1080/13816810.2020.1766085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To study the impact of a Retinoblastoma (Rb) screening program in the absence of genetic testing on the management and outcome of high-risk children. METHODS This is a retrospective, clinical case series of 76 children from families involved in a Rb screening program as they had higher than normal risk as calculated by the conventional ways without genetic testing. Data included calculated risk, method of diagnosis, demographics, tumor features, treatment modalities, and management outcome. RESULTS Out of the 76 children screened, 46 children were diagnosed with Rb (12 by screening and 34 had signs of Rb), the other 30 were free of disease. Patients diagnosed by screening were younger (mean; 2.4 months vs 15.8 months for the group with signs of Rb), had significantly earlier tumor stage at diagnosis (p = .0001), higher eye salvage rate (p = .0001), less need for systemic chemotherapy (p = .022), and better visual outcome (p = .0017) than the other group. None of the eyes were group D or E, enucleated or irradiated. Six (50%) patients were cured without chemotherapy, and the visual acuity was 0.5 or better in 55% of eyes. Of interest, 71% of tumors were diagnosed by the age of 6 months, 90% by the age of 1 year, and no new tumor appeared after the age of 2 years. CONCLUSION Even in the absence of genetic testing, screening for children with high risk for Rb is effective in enhancing early diagnosis, improving visual outcome, and increasing eye salvage rate with limited exposure to treatment burden.
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Affiliation(s)
- Yacoub A Yousef
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Abdelrahman Alkhoms
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Reem AlJabari
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Mays AlJboor
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Mona Mohammad
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Maha Lahlouh
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Rasha Deebajah
- Pediatrics Oncology, King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Hadeel Halalsheh
- Pediatrics Oncology, King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Maysa Al-Hussaini
- Pathology and Laboratory Medicine, King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Imad Jaradat
- Anesthesia, King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Munir Shawagfeh
- Radiation Oncology, King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Iyad Sultan
- Pediatrics Oncology, King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Mustafa Mehyar
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Ibrahim AlNawaiseh
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
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Munson MC, Plewman DL, Baumer KM, Henning R, Zahler CT, Kietzman AT, Beard AA, Mukai S, Diller L, Hamerly G, Shaw BF. Autonomous early detection of eye disease in childhood photographs. SCIENCE ADVANCES 2019; 5:eaax6363. [PMID: 31616792 PMCID: PMC6774731 DOI: 10.1126/sciadv.aax6363] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/10/2019] [Indexed: 05/14/2023]
Abstract
The "red reflex test" is used to screen children for leukocoria ("white eye") in a standard pediatric examination, but is ineffective at detecting many eye disorders. Leukocoria also presents in casual photographs. The clinical utility of screening photographs for leukocoria is unreported. Here, a free smartphone application (CRADLE: ComputeR-Assisted Detector of LEukocoria) was engineered to detect photographic leukocoria and is available for download under the name "White Eye Detector." This study determined the sensitivity, specificity, and accuracy of CRADLE by retrospectively analyzing 52,982 longitudinal photographs of children, collected by parents before enrollment in this study. The cohort included 20 children with retinoblastoma, Coats' disease, cataract, amblyopia, or hyperopia and 20 control children. For 80% of children with eye disorders, the application detected leukocoria in photographs taken before diagnosis by 1.3 years (95% confidence interval, 0.4 to 2.3 years). The CRADLE application allows parents to augment clinical leukocoria screening with photography.
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Affiliation(s)
- Micheal C. Munson
- Department of Chemistry and Biochemistry, Baylor University, Waco, TX, USA
| | - Devon L. Plewman
- Department of Chemistry and Biochemistry, Baylor University, Waco, TX, USA
| | - Katelyn M. Baumer
- Department of Chemistry and Biochemistry, Baylor University, Waco, TX, USA
| | - Ryan Henning
- Department of Computer Science, Baylor University, Waco, TX, USA
| | - Collin T. Zahler
- Department of Chemistry and Biochemistry, Baylor University, Waco, TX, USA
| | | | - Alexandra A. Beard
- Department of Chemistry and Biochemistry, Baylor University, Waco, TX, USA
| | - Shizuo Mukai
- Retina Service, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lisa Diller
- Harvard Medical School, Boston, MA, USA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Greg Hamerly
- Department of Computer Science, Baylor University, Waco, TX, USA
| | - Bryan F. Shaw
- Department of Chemistry and Biochemistry, Baylor University, Waco, TX, USA
- Corresponding author.
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Touhami S, Audo I, Terrada C, Gaudric A, LeHoang P, Touitou V, Bodaghi B. Neoplasia and intraocular inflammation: From masquerade syndromes to immunotherapy-induced uveitis. Prog Retin Eye Res 2019; 72:100761. [DOI: 10.1016/j.preteyeres.2019.05.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 04/16/2019] [Accepted: 05/01/2019] [Indexed: 12/18/2022]
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Wang L, Wang L, Li L, Zhang H, Lyu X. MicroRNA‑330 is downregulated in retinoblastoma and suppresses cell viability and invasion by directly targeting ROCK1. Mol Med Rep 2019; 20:3440-3447. [PMID: 31432120 DOI: 10.3892/mmr.2019.10545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 02/08/2019] [Indexed: 11/06/2022] Open
Abstract
Abnormal expression of microRNAs (miRNAs/miRs) has been previously reported in various types of human cancer, such as retinoblastoma (RB). Dysregulated miRNAs have been demonstrated to be important epigenetic regulators of numerous biological events associated with RB. Therefore, improved understanding of the precise roles of miRNAs in RB is required to develop novel therapeutic strategies for the treatment of patients with this disease. In the present study, reverse transcription‑quantitative polymerase chain reaction (RT‑qPCR) was performed to detect miR‑330 expression in RB tissues and cell lines. The effects of miR‑330 overexpression on the viability and invasion of RB cells were determined using MTT and Matrigel®‑based invasion assays, respectively. The mechanisms underlying the activity of miR‑330 in RB cells were investigated via bioinformatics analysis, luciferase reporter assays, and RT‑qPCR and western blot analyses. It was revealed that the levels of miR‑330 expression were significantly downregulated in RB tissues and cell lines compared with in control healthy tissues and cells, respectively. Overexpression of miR‑330 in RB cells significantly reduced the viability and invasion of cells in vitro. Additionally, ρ‑associated coiled‑coil containing protein kinase 1 (ROCK1) was identified as a putative target of miR‑330 using bioinformatics analysis. Subsequent experiments revealed that miR‑330 interacted with the 3'‑untranslated region of ROCK1 and downregulated its expression in RB cells. Furthermore, the expression levels of ROCK1 were increased in RB tissues compared with healthy controls and negatively correlated with miR‑330 expression. Finally, upregulation of ROCK1 expression reversed the miR‑330‑induced inhibition of the viability and invasion of RB cells. Collectively, these results suggested that miR‑330 exhibits tumor‑suppressor activity in the development of RB by directly targeting ROCK1, indicating that restoration of miR‑330 expression may be a promising therapeutic technique in the treatment of patients with RB.
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Affiliation(s)
- Ling Wang
- Department of Ophthalmology, China‑Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Lina Wang
- Department of Ophthalmology, China‑Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Lin Li
- Department of Ophthalmology, China‑Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Hong Zhang
- Department of Ophthalmology, China‑Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Xueman Lyu
- Department of Ophthalmology, China‑Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
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Gürsel Özkurt Z, Balsak S, Çamçi MS, Bilgen K, Katran İH, Aslan A, Han ÇÇ. Approach of Family Physicians to Pediatric Eye Screening in Diyarbakır. Turk J Ophthalmol 2019; 49:25-29. [PMID: 30829022 PMCID: PMC6416478 DOI: 10.4274/tjo.galenos.2018.10829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objectives In Turkey, preventive medicine services are the responsibility of family physicians and vision screening is a key component of this responsibility. In this study, we aimed to investigate the approach of family physicians to vision screening in infants and children. Materials and Methods Data were collected using a 16-item questionnaire administered to 100 family physicians working in the center and provinces of Diyarbakır. Results The results indicated that 88 (88%) physicians declared knowing what the red reflex test was, while 12 physicians declared that they had never heard of it. Only 16 (16%) physicians performed the test routinely and 36 (36%) physicians performed it only in suspicious cases. Ten (10%) physicians indicated that they did not refer the patients to an ophthalmologist even though they did not perform the red reflex test. Moreover, 5 (5%) physicians did not have an ophthalmoscope and 12 (12%) physicians reported not knowing how to use an ophthalmoscope. Forty (40%) of the physicians measured preschool visual acuity at least once. Sixty-six (66%) physicians referred younger children who could not express their vision problems to an ophthalmologist. Four (4%) physicians declared that they would delay surgery in children with strabismus until they were old enough for surgery. Ninety-three (93%) physicians suggested that educational seminars about vision screening would be beneficial. Conclusion Educational seminars about vision screening may have favorable outcomes. The medical devices in family medicine centers should be improved. Vision screening can be added to the negative performance-based compensation system in order to increase physicians’ attention to vision screening. To implement detailed eye screening programs like those in developed countries, an infrastructure should be established for this screening program.
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Affiliation(s)
- Zeynep Gürsel Özkurt
- Dicle University Faculty of Medicine, Department of Ophthalmology, Diyarbakır, Turkey
| | - Selahattin Balsak
- University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Ophthalmology Clinic, Diyarbakır, Turkey
| | - Mehmet Sinan Çamçi
- Dicle University Faculty of Medicine, Department of Ophthalmology, Diyarbakır, Turkey
| | - Kadir Bilgen
- Dicle University Faculty of Medicine, Department of Ophthalmology, Diyarbakır, Turkey
| | - İbrahim Halil Katran
- Dicle University Faculty of Medicine, Department of Ophthalmology, Diyarbakır, Turkey
| | - Adar Aslan
- Dicle University Faculty of Medicine, Department of Ophthalmology, Diyarbakır, Turkey
| | - Çağla Çilem Han
- Dicle University Faculty of Medicine, Department of Ophthalmology, Diyarbakır, Turkey
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Cheng Y, Liu W. MicroRNA-503 serves an oncogenic role in retinoblastoma progression by directly targeting PTPN12. Exp Ther Med 2019; 18:2285-2292. [PMID: 31410179 DOI: 10.3892/etm.2019.7795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 04/05/2019] [Indexed: 12/16/2022] Open
Abstract
Numerous studies have demonstrated that microRNAs (miRNAs or miRs) are abnormally expressed in retinoblastoma (RB). miRNAs may serve a role in oncogene or tumor-suppressor activity in RB genesis and development by modulating various biological processes. miRNAs therefore, may be effective therapeutic targets for miRNA-based therapy in patients with RB. Recently it has been revealed that miR-503 may serve a role in various types of human cancer. However, the expression and functional roles of miR-503 are rarely reported in RB. In the current study, the expression of miR-503 was significantly upregulated in RB tissues and cell lines. In addition, Cell Counting Kit-8 and in vitro invasion assays were performed to assess cell proliferation and invasion, respectively. The results of the present study revealed that miR-503 inhibition impeded RB in vitro cell proliferation and invasion. Furthermore, protein tyrosine phosphatase nonreceptor type 12 (PTPN12) was demonstrated to be a direct target gene of miR-503 in RB cells. PTPN12 overexpression also led to the downregulation of miR-503 in RB cell proliferation and invasion. PTPN12 knockdown could therefore abrogate the effects of miR-503 downregulation in RB cells. In conclusion, the results demonstrated that miR-503 may serve a role in RB oncogenic activity progression by directly targeting PTPN12. Therefore, miR-503 may be a target for effective therapy in patients with RB.
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Affiliation(s)
- Yang Cheng
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Wei Liu
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
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Munier FL, Beck-Popovic M, Chantada GL, Cobrinik D, Kivelä TT, Lohmann D, Maeder P, Moll AC, Carcaboso AM, Moulin A, Schaiquevich P, Bergin C, Dyson PJ, Houghton S, Puccinelli F, Vial Y, Gaillard MC, Stathopoulos C. Conservative management of retinoblastoma: Challenging orthodoxy without compromising the state of metastatic grace. "Alive, with good vision and no comorbidity". Prog Retin Eye Res 2019; 73:100764. [PMID: 31173880 DOI: 10.1016/j.preteyeres.2019.05.005] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/25/2019] [Accepted: 05/29/2019] [Indexed: 12/21/2022]
Abstract
Retinoblastoma is lethal by metastasis if left untreated, so the primary goal of therapy is to preserve life, with ocular survival, visual preservation and quality of life as secondary aims. Historically, enucleation was the first successful therapeutic approach to decrease mortality, followed over 100 years ago by the first eye salvage attempts with radiotherapy. This led to the empiric delineation of a window for conservative management subject to a "state of metastatic grace" never to be violated. Over the last two decades, conservative management of retinoblastoma witnessed an impressive acceleration of improvements, culminating in two major paradigm shifts in therapeutic strategy. Firstly, the introduction of systemic chemotherapy and focal treatments in the late 1990s enabled radiotherapy to be progressively abandoned. Around 10 years later, the advent of chemotherapy in situ, with the capitalization of new routes of targeted drug delivery, namely intra-arterial, intravitreal and now intracameral injections, allowed significant increase in eye preservation rate, definitive eradication of radiotherapy and reduction of systemic chemotherapy. Here we intend to review the relevant knowledge susceptible to improve the conservative management of retinoblastoma in compliance with the "state of metastatic grace", with particular attention to (i) reviewing how new imaging modalities impact the frontiers of conservative management, (ii) dissecting retinoblastoma genesis, growth patterns, and intraocular routes of tumor propagation, (iii) assessing major therapeutic changes and trends, (iv) proposing a classification of relapsing retinoblastoma, (v) examining treatable/preventable disease-related or treatment-induced complications, and (vi) appraising new therapeutic targets and concepts, as well as liquid biopsy potentiality.
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Affiliation(s)
- Francis L Munier
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland.
| | - Maja Beck-Popovic
- Unit of Pediatric Hematology-Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Guillermo L Chantada
- Hemato-Oncology Service, Hospital JP Garrahan, Buenos Aires, Argentina; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - David Cobrinik
- The Vision Center and The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA; USC Roski Eye Institute, Department of Biochemistry & Molecular Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Tero T Kivelä
- Department of Ophthalmology, Ocular Oncology and Pediatric Ophthalmology Services, Helsinki University Hospital, Helsinki, Finland
| | - Dietmar Lohmann
- Eye Oncogenetics Research Group, Institute of Human Genetics, University Hospital Essen, Essen, Germany
| | - Philippe Maeder
- Unit of Neuroradiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Annette C Moll
- UMC, Vrije Universiteit Amsterdam, Department of Ophthalmology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Angel Montero Carcaboso
- Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Alexandre Moulin
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Paula Schaiquevich
- Unit of Clinical Pharmacokinetics, Hospital de Pediatria JP Garrahan, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Ciara Bergin
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Paul J Dyson
- Institut des Sciences et Ingénierie Chimiques, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015, Lausanne, Switzerland
| | - Susan Houghton
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Francesco Puccinelli
- Interventional Neuroradiology Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Yvan Vial
- Materno-Fetal Medicine Unit, Woman-Mother-Child Department, University Hospital of Lausanne, Switzerland
| | - Marie-Claire Gaillard
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Christina Stathopoulos
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
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Yousef YA, AlNawaiseh T, AlJabari R, Muhsen S, Al-Nawaiseh I. Retinoblastoma awareness among first contact physicians in Jordan. Ophthalmic Genet 2019; 40:191-195. [DOI: 10.1080/13816810.2019.1605387] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Yacoub A. Yousef
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman, Jordan
| | - Tamara AlNawaiseh
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman, Jordan
| | - Reem AlJabari
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman, Jordan
| | - Sana’ Muhsen
- Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Ibrahim Al-Nawaiseh
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman, Jordan
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Khedekar A, Devarajan B, Ramasamy K, Muthukkaruppan V, Kim U. Smartphone-based application improves the detection of retinoblastoma. Eye (Lond) 2019; 33:896-901. [PMID: 30635644 DOI: 10.1038/s41433-018-0333-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 11/29/2018] [Accepted: 12/20/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To improve and validate the smartphone-based leukocoria detection application so that non-ophthalmologists could make use of the smartphone for early detection of Retinoblastoma (RB) in young children without anesthesia and pharmacological dilatation of the pupil. METHODS Two apps, MDEyeCare and CRADLE, developed for red reflex based leukocoria detection were used in iPhone 6s. MDEyeCare methodology was modified with respect to ambient lighting, the distance between camera and eye and different gazes for better performance. We analyzed totally 34 eyes of 23 RB patients and four normal children. Each of the RB patients was confirmed with clinical examination and radiological investigations. RESULTS Modification in the methodology of MDEyeCare app could detect the leukocoria in early stages of RB (50% of Group B, 83% of Group C). In late stages (Group D and E), 100% of tumors were detected. The CRADLE app failed to provide adequate leukocoria detection except four late stage RB eyes. Among the 14 normal eyes (6 from unilateral RB and eight from normal children), pseudo-leukocoria was observed in three eyes only at lateral gaze even with MDEyeCare app. CONCLUSION Improved methodology in smartphone-based app enhanced the detection of RB and this may translate into better outcome after treatment with respect to vision salvage.
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Affiliation(s)
- Amit Khedekar
- Department of Orbit, Oculoplasty and Oncology, Aravind Eye Hospital, Madurai, India.,Khedekar's Eye Clinic, Mumbai, India
| | | | - Kim Ramasamy
- Department of Retina, Aravind Eye Hospital, Madurai, India
| | | | - Usha Kim
- Department of Orbit, Oculoplasty and Oncology, Aravind Eye Hospital, Madurai, India
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Cao Q, Wang Y, Song X, Yang W. Association between MDM2 rs2279744, MDM2 rs937283, and p21 rs1801270 polymorphisms and retinoblastoma susceptibility. Medicine (Baltimore) 2018; 97:e13547. [PMID: 30544467 PMCID: PMC6314785 DOI: 10.1097/md.0000000000013547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Retinoblastoma (Rb) is the most common intra-ocular malignancy in children. The association of rs2279744, and rs937283 in MDM2 gene, and p21 rs1801270 polymorphism and RB development have been demonstrated. To provide a comprehensive assessment of and to clarify associations between the 3 SNPs (MDM2 rs2279744, MDM2 rs937283, and p21 rs1801270) and the risk of RB, we performed a meta-analysis of all the eligible case-control studies. We searched English databases include PubMed, Embase, Google Scholar, and Cochrane Library, using an upper date limit of January 1, 2018. The association between MDM2 rs2279744, MDM2 rs937283, and p21 rs1801270 polymorphisms and the risk of RB were estimated by calculating a pooled OR and 95% CI under a homozygote comparison, heterozygote comparison, dominant model, and recessive model. The statistical power analysis was performed using G*Power. Our meta-analysis showed a significant association between RB susceptibility and MDM2 rs2279744 recessive model (OR = 1.427, 95%CI: 1.107-1.840, P = .006, I = 0%). Moreover, a significant link was observed between RB risk and MDM2 rs937283 homozygote comparison (OR = 0.471, 95%CI: 0.259-0.858, P = .014, I = 0%) and recessive model (OR = 0.587, 95%CI: 0.410-0.840, P = .004, I = 0%). However, no significant relationship between the p21 rs1801270 polymorphism and RB susceptibility was detected in any of the 4 models (P > .05). In conclusion, we found that significant association between the MDM2 rs2279744 polymorphism and increased RB risk, while MDM2 rs937283 polymorphism was associated with significantly decreased RB risk. However, as to the P21 rs1801270 polymorphism, a statistically significant association was not identified for RB.
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Affiliation(s)
- Qixin Cao
- Department of Ophthalmology, Huzhou Hospital of Traditional Chinese Medicine, Huzhou
| | - Yun Wang
- Department of Ophthalmology, Ningbo Eye Hospital, Ningbo
| | - Xiaohui Song
- Department of Ophthalmology, Nanxun District Hospital of Traditional Chinese Medicine, Huzhou
| | - Weihua Yang
- Department of Ophthalmology, the First Affiliated Hospital of Huzhou University, Huzhou, Zhejiang, China
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Jain M, Rojanaporn D, Chawla B, Sundar G, Gopal L, Khetan V. Retinoblastoma in Asia. Eye (Lond) 2018; 33:87-96. [PMID: 30385881 DOI: 10.1038/s41433-018-0244-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 09/23/2018] [Accepted: 10/04/2018] [Indexed: 01/22/2023] Open
Abstract
Asia-Pacific region bears a significant global burden of retinoblastoma (RB), therefore understanding RB in Asia-Pacific region is important. Based on the year 2013 population estimates, 43% (3452 of 8099 children) of the global burden of RB lives in 6 countries of Asia-Pacific region: 1486 children in India, 1103 children in China, 277 children in Indonesia, 260 children in Pakistan, 184 children in Bangladesh, 142 children in Philippines. There exists a wide disparity, technological and socio-economical, within countries in this region resulting in a varied pattern of clinical presentation and survival varies. Challenges in developing nations are not just technological, but also social. Opportunities emerge for research to study and understand the socio-economical aspects of the disease to develop interventions that are relevant culturally and feasible economically. Possible steps include disease education and counselling, universal screening, highly subsidized/free of cost treatment for low socioeconomic strata, raising funds through the government and non-governmental organizations, sensitization and training of man-power in screening, diagnosis and treatment, and developing new specialized centers with tele-ophthalmology services.
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Affiliation(s)
- Mukesh Jain
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, 600006, Tamil Nadu, India
| | - Duangnate Rojanaporn
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University Faculty of Medicine, Bangkok, Thailand
| | - Bhavna Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Gangadhar Sundar
- Retinoblastoma Service, Department of Ophthalmology, National University Hospital, National University of, Singapore, 119074, Singapore
| | - Lingam Gopal
- Retinoblastoma Service, Department of Ophthalmology, National University Hospital, National University of, Singapore, 119074, Singapore
| | - Vikas Khetan
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, 600006, Tamil Nadu, India.
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40
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Strabismus in retinoblastoma survivors with long-term follow-up. J AAPOS 2018; 22:276.e1-276.e7. [PMID: 30009948 DOI: 10.1016/j.jaapos.2018.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/14/2018] [Accepted: 03/22/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the long-term strabismus rate in salvaged retinoblastoma (Rb) patients and investigate possible risk factors leading to strabismus. METHODS The medical records of patients with Rb presenting at a single institution over a 9-year period were reviewed retrospectively with regard to ocular alignment outcomes after long-term follow-up. RESULTS A total of 64 eyes of 42 patients (22 bilateral cases [52%]) were included, presenting with International Intraocular Retinoblastoma Classification (IIRC) in the worse eye as follows: group A (n = 1), B (n = 16), C (n = 12), D (n = 11), no Rb (n = 2). Fifteen patients (36%) were initially referred because of family history of Rb. Mean age at presentation was 8.2 months (range, 0.3-58.3 months). Overall treatments included intravenous chemotherapy (62 eyes), intraophthalmic artery chemotherapy (10 eyes), brachytherapy (11 eyes), transpupillary thermotherapy (22 eyes), cryotherapy (47 eyes), and external beam radiotherapy (4 eyes). At final follow-up (mean, 93.7 months), 69% of patients had strabismus, with exotropia being the most common type (n = 18), followed by esotropia (n = 8), and alternate exotropia/esotropia (n = 3). On univariate analysis, the worse eye group IIRC and cTNMH, sporadic cases, strabismus, and foveal tumor at presentation were found to be significantly associated with strabismus at final follow-up (P ≤ 0.043). On multivariate analysis, only foveal involvement was found to be significant (P < 0.001). CONCLUSIONS Strabismus, exotropia in particular, is a common adverse sequela following successful conservative treatment for Rb, with 69% of the present cohort having some type of deviation after long-term follow-up, for which foveal tumor at presentation was found to be a significant risk factor.
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Gargallo P, Oltra JS, Yáñez Y, Segura V, Balaguer J, Cañete A. Retinoblastoma: towards an earlier diagnosis. ACTA ACUST UNITED AC 2018; 93:439-443. [PMID: 29929761 DOI: 10.1016/j.oftal.2018.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/26/2018] [Accepted: 05/09/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The number of enucleations and visual sequels due to retinoblastoma is high. The aim of this study was to evaluate the different diagnostic aspects and propose strategies that might improve the clinical management of this condition. METHOD A retrospective study was conducted on 38 patients with retinoblastoma studied genetically (29 unilateral, 9 bilateral). The evaluation included: age of onset, clinical signs, and time since onset, number of enucleations, time to diagnosis, and survival at 5 years. RESULTS Leukocoria was the main clinical sign (present in 90% of cases). The mean diagnostic delay was 3.2 months. Among the unilateral cases, the eyes were enucleated in 76%, and 55% in the bilateral forms. Only one death was found among the 25 patients followed-up for at least 5 years. CONCLUSIONS Retinoblastoma diagnostic and treatment strategies need to be updated. Good coordination between paediatricians and ophthalmologists is essential for this. Its management in reference centres, which have the necessary technology and experience, should contribute to increase the rate of organ preservation.
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Affiliation(s)
- P Gargallo
- Grupo de Investigación Clínica y Traslacional en Cáncer, Instituto de Investigación Sanitaria La Fe, Valencia, España.
| | - J S Oltra
- Servicio de Genética Médica, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Y Yáñez
- Grupo de Investigación Clínica y Traslacional en Cáncer, Instituto de Investigación Sanitaria La Fe, Valencia, España
| | - V Segura
- Grupo de Investigación Clínica y Traslacional en Cáncer, Instituto de Investigación Sanitaria La Fe, Valencia, España
| | - J Balaguer
- Oncología Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - A Cañete
- Oncología Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, España
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Wei D, Miao Y, Yu L, Wang D, Wang Y. Downregulation of microRNA‑198 suppresses cell proliferation and invasion in retinoblastoma by directly targeting PTEN. Mol Med Rep 2018; 18:595-602. [PMID: 29749457 DOI: 10.3892/mmr.2018.8979] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/20/2018] [Indexed: 11/05/2022] Open
Abstract
A number of studies have highlighted that aberrantly expressed microRNAs (miRNAs/miRs) serve crucial roles in the tumorigenesis and tumor development of retinoblastoma (RB). Hence, a full investigation of the biological roles and regulatory mechanisms of miRNAs in RB may provide novel therapeutic targets for patients with this malignancy. miR‑198 is frequently abnormally expressed in various types of human cancers. However, the expression level, biological roles and underlying mechanisms of miR‑198 in RB remain to be elucidated. In the present study, miR‑198 expression was upregulated in RB tissues and cell lines. Silencing of miR‑198 attenuated cell proliferation and invasion in RB. In addition, phosphatase and tensin homolog deleted on chromosome ten (PTEN) was predicted as a potential target of miR‑198 using bioinformatics analysis. Subsequent luciferase reporter assay indicated that the 3'‑untranslated region of PTEN can be directly targeted by miR‑198. Furthermore, miR‑198 inhibition increased the PTEN expression at the mRNA and protein levels in RB cells. In addition, PTEN mRNA expression was downregulated in RB tissues, and this downregulation was inversely associated with the expression level of miR‑198. PTEN knockdown rescued the inhibitory effects of miR‑198 underexpression on cell proliferation and invasion in RB. Notably, the downregulation of miR‑198 inactivated the phosphoinositide 3‑kinase (PI3K)/protein kinase B (AKT) signaling pathway in RB. These results demonstrated that miR‑198 may serve oncogenic roles in RB by directly targeting PTEN and regulating the PI3K/AKT signaling pathway. Hence, miR‑198 may be a promising therapeutic target for patients with RB.
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Affiliation(s)
- Dongdong Wei
- Department of Ophthalmology, Dezhou People's Hospital, Dezhou, Shandong 253000, P.R. China
| | - Yingbin Miao
- Department of Ophthalmology, Dezhou People's Hospital, Dezhou, Shandong 253000, P.R. China
| | - Lianxia Yu
- Department of Ophthalmology, The Second People Hospital of Dezhou, Dezhou, Shandong 253024, P.R. China
| | - Degong Wang
- Department of Ophthalmology, Dezhou People's Hospital, Dezhou, Shandong 253000, P.R. China
| | - Yingli Wang
- Department of Ophthalmology, Yantai Yeda Hospital, Yantai, Shandong 264006, P.R. China
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Kamihara J, Bourdeaut F, Foulkes WD, Molenaar JJ, Mossé YP, Nakagawara A, Parareda A, Scollon SR, Schneider KW, Skalet AH, States LJ, Walsh MF, Diller LR, Brodeur GM. Retinoblastoma and Neuroblastoma Predisposition and Surveillance. Clin Cancer Res 2018; 23:e98-e106. [PMID: 28674118 DOI: 10.1158/1078-0432.ccr-17-0652] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/02/2017] [Accepted: 05/09/2017] [Indexed: 12/28/2022]
Abstract
Retinoblastoma (RB) is the most common intraocular malignancy in childhood. Approximately 40% of retinoblastomas are hereditary and due to germline mutations in the RB1 gene. Children with hereditary RB are also at risk for developing a midline intracranial tumor, most commonly pineoblastoma. We recommend intensive ocular screening for patients with germline RB1 mutations for retinoblastoma as well as neuroimaging for pineoblastoma surveillance. There is an approximately 20% risk of developing second primary cancers among individuals with hereditary RB, higher among those who received radiotherapy for their primary RB tumors. However, there is not yet a clear consensus on what, if any, screening protocol would be most appropriate and effective. Neuroblastoma (NB), an embryonal tumor of the sympathetic nervous system, accounts for 15% of pediatric cancer deaths. Prior studies suggest that about 2% of patients with NB have an underlying genetic predisposition that may have contributed to the development of NB. Germline mutations in ALK and PHOX2B account for most familial NB cases. However, other cancer predisposition syndromes, such as Li-Fraumeni syndrome, RASopathies, and others, may be associated with an increased risk for NB. No established protocols for NB surveillance currently exist. Here, we describe consensus recommendations on hereditary RB and NB from the AACR Childhood Cancer Predisposition Workshop. Clin Cancer Res; 23(13); e98-e106. ©2017 AACRSee all articles in the online-only CCR Pediatric Oncology Series.
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Affiliation(s)
- Junne Kamihara
- Dana-Farber Cancer Institute, Boston Children's Hospital, Boston, Massachusetts
| | | | - William D Foulkes
- Human Genetics, Medicine and Oncology, McGill University, Montreal, Québec, Canada
| | - Jan J Molenaar
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Yaël P Mossé
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Andreu Parareda
- Sant Joan de Deu, Barcelona Children's Hospital, Barcelona, Catalonia, Spain
| | | | | | - Alison H Skalet
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon
| | - Lisa J States
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Lisa R Diller
- Dana-Farber Cancer Institute, Boston Children's Hospital, Boston, Massachusetts
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AlAli A, Kletke S, Gallie B, Lam WC. Retinoblastoma for Pediatric Ophthalmologists. Asia Pac J Ophthalmol (Phila) 2018; 7:160-168. [PMID: 29737052 DOI: 10.22608/apo.201870] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Retinoblastoma can present in 1 or both eyes and is the most common intraocular malignancy in childhood. It is typically initiated by biallelic mutation of the RB1 tumor suppressor gene, leading to malignant transformation of primitive retinal cells. The most common presentation is leukocoria, followed by strabismus. Heritable retinoblastoma accounts for 45% of all cases, with 80% being bilateral. Treatment and prognosis of retinoblastoma is dictated by the disease stage at initial presentation. The 8th Edition American Joint Committee on Cancer (AJCC) TNMH (tumor, node, metastasis, heritable trait) staging system defines evidence-based clinical and pathological staging for overall prognosis for eye(s) and child. Multiple treatment options are available in 2018 for retinoblastoma management with a multidisciplinary team, including pediatric ocular oncology, medical oncology, radiation oncology, genetics, nursing, and social work. Survival exceeds 95% when disease is diagnosed early and treated in centers specializing in retinoblastoma. However, survival rates are less than 50% with extraocular tumor dissemination. We summarize the epidemiology, genetics, prenatal screening, diagnosis, classification, investigations, and current therapeutic options in the management of retinoblastoma.
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Affiliation(s)
- Alaa AlAli
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Canada
| | - Stephanie Kletke
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Canada
| | - Brenda Gallie
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Canada
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, Canada
- Techna Institute, University Health Network, Toronto, Canada
- Departments of Molecular Genetics and Medical Biophysics, University of Toronto, Toronto, Canada
| | - Wai-Ching Lam
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, Canada
- Department of Ophthalmology, The University of Hong Kong, Hong Kong
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Staffieri SE, Kearns LS, Sanfilippo PG, Craig JE, Mackey DA, Hewitt AW. Crowd-sourced Ontology for Photoleukocoria: Identifying Common Internet Search Terms for a Potentially Important Pediatric Ophthalmic Sign. Transl Vis Sci Technol 2018; 7:18. [PMID: 29464132 PMCID: PMC5815559 DOI: 10.1167/tvst.7.1.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 12/14/2017] [Indexed: 12/23/2022] Open
Abstract
Purpose Leukocoria is the most common presenting sign for pediatric eye disease including retinoblastoma and cataract, with worse outcomes if diagnosis is delayed. We investigated whether individuals could identify leukocoria in photographs (photoleukocoria) and examined their subsequent Internet search behavior. Methods Using a web-based questionnaire, in this cross-sectional study we invited adults aged over 18 years to view two photographs of a child with photoleukocoria, and then search the Internet to determine a possible diagnosis and action plan. The most commonly used search terms and websites accessed were recorded. Results The questionnaire was completed by 1639 individuals. Facebook advertisement was the most effective recruitment strategy. The mean age of all respondents was 38.95 ± 14.59 years (range, 18-83), 94% were female, and 59.3% had children. An abnormality in the images presented was identified by 1613 (98.4%) participants. The most commonly used search terms were: "white," "pupil," "photo," and "eye" reaching a variety of appropriate websites or links to print or social media articles. Conclusions Different words or phrases were used to describe the same observation of photoleukocoria leading to a range of websites. Variations in the description of observed signs and search words influenced the sites reached, information obtained, and subsequent help-seeking intentions. Translational Relevance Identifying the most commonly used search terms for photoleukocoria is an important step for search engine optimization. Being directed to the most appropriate websites informing of the significance of photoleukocoria and the appropriate actions to take could improve delays in diagnosis of important pediatric eye disease such as retinoblastoma or cataract.
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Affiliation(s)
- Sandra E Staffieri
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.,Ophthalmology, University of Melbourne, Department of Surgery, Melbourne, VIC, Australia
| | - Lisa S Kearns
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.,Ophthalmology, University of Melbourne, Department of Surgery, Melbourne, VIC, Australia
| | - Paul G Sanfilippo
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.,Ophthalmology, University of Melbourne, Department of Surgery, Melbourne, VIC, Australia
| | - Jamie E Craig
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Adelaide, SA, Australia
| | - David A Mackey
- Menzies Institute for Medical Research, School of Medicine, University of Tasmania, Hobart, TAS, Australia.,Lion's Eye Institute, Centre for Ophthalmology and Visual Sciences, University of Western Australia, Perth, WA, Australia
| | - Alex W Hewitt
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.,Ophthalmology, University of Melbourne, Department of Surgery, Melbourne, VIC, Australia.,Menzies Institute for Medical Research, School of Medicine, University of Tasmania, Hobart, TAS, Australia
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Parma D, Ferrer M, Luce L, Giliberto F, Szijan I. RB1 gene mutations in Argentine retinoblastoma patients. Implications for genetic counseling. PLoS One 2017; 12:e0189736. [PMID: 29261756 PMCID: PMC5738096 DOI: 10.1371/journal.pone.0189736] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/30/2017] [Indexed: 11/21/2022] Open
Abstract
Retinoblastoma (RB) is an inherited childhood ocular cancer caused by mutations in the tumor suppressor RB1 gene. Identification of RB1 mutations is essential to assess the risk of developing retinoblastoma in the patients´ relatives. Retinoblastoma is a potentially curable cancer and an early diagnosis is critical for survival and eye preservation. Unilateral retinoblastoma is mostly non-heritable and results from two somatic mutations whereas bilateral retinoblastoma is heritable and results from one germline and one somatic mutation, both have high penetrance, 90%. The purpose of this study was to identify causative RB1 mutations in RB patients with different clinical presentations. A comprehensive approach was used to study a cohort of 34 patients with unilateral, bilateral and trilateral retinoblastoma. Blood and tumor DNA was analyzed by sequencing and multiplex ligation-dependent probe amplification (MLPA) assay. Validation of an insertion mutation was performed by cloning the PCR product. Most of the patients in our cohort had unilateral RB, eight patients had bilateral RB and one patient had a trilateral tumor with ocular and suprasellar/sellar locations. Other tumors in addition to retinoblastoma were also found in the affected families. One patient had two syndromes, retinoblastoma and schwannomatosis, and another RB patient had a father with a retinoma. Five out of the 25 unilateral RB patients carried germinal mutations (20%), which were mostly missense mutations. The bilateral and trilateral patients carried splice-site, nonsense and frameshift mutations as well as a whole RB1 gene deletion. Missense mutations were associated with mild phenotype: unilateral retinoblastoma, retinoma or no tumor. In this study we identified causative RB1 mutations in most bilateral RB patients and in some unilateral RB patients, including five novel mutations. These data are crucial for genetic counseling and confirm the need to perform complete genetic screening for RB1 mutations in both constitutional and tumor tissues.
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Affiliation(s)
- Diana Parma
- Cátedra de Genética, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires. Buenos Aires. Argentina
| | - Marcela Ferrer
- Division de Neurocirugia, Hospital de Clinicas “Jose de San Martin”, Universidad de Buenos Aires. Buenos Aires. Argentina
| | - Leonela Luce
- Cátedra de Genética, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires. Buenos Aires. Argentina
| | - Florencia Giliberto
- Cátedra de Genética, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires. Buenos Aires. Argentina
| | - Irene Szijan
- Cátedra de Genética, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires. Buenos Aires. Argentina
- * E-mail:
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Posner M, Jaulim A, Vasalaki M, Rantell K, Sagoo MS, Reddy MA. Lag time for retinoblastoma in the UK revisited: a retrospective analysis. BMJ Open 2017; 7:e015625. [PMID: 28710216 PMCID: PMC5734263 DOI: 10.1136/bmjopen-2016-015625] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To explore current delays in diagnosis of retinoblastoma (Rb) and effect on outcome with comparison to a study from the 1990s. SETTING Primary, secondary, tertiary care: majority from South of England. PARTICIPANTS A retrospective analysis of 93 new referrals of sporadic (non-familial) Rb to a specialist Rb unit in London, UK from January 2006 to February 2014. PRIMARY AND SECONDARY OUTCOMES International Intraocular Retinoblastoma Classification, lag times including parental delay and healthcare professional delay, patients requiring enucleation and requirement of adjuvant chemotherapy postenucleation (high-risk Rb). RESULTS During the study period, 29% presented via accident and emergency (A&E). The median referral time from symptom onset to visiting primary care (PC) was 28 days and PC to ophthalmologist 3 days (range 0-181 days). The median time from local ophthalmologist to the Rb Unit was 6 days (0-33). No significant correlation was found between delay and International Classification of Retinoblastoma grade (p>0.05) or between postenucleation adjuvant chemotherapy and enucleation groups (p>0.05). Less enucleations (60%) are being performed compared with the previous study (81%) (p=0.0015). CONCLUSIONS Parents are attending A&E more compared with the 1990s and this may reflect the effect of public awareness campaigns. More eyes are being salvaged despite a similar number of children requiring adjuvant chemotherapy. High-risk Rb and Group E eyes do not correlate with increased lag time in the UK. Other determinants such as tumour biology may be more relevant.
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Affiliation(s)
- Marcus Posner
- Retinoblastoma Unit, Department of Ophthalmology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Adil Jaulim
- Retinoblastoma Unit, Department of Ophthalmology, Royal London Hospital, Barts Health NHS Trust, London, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, London, UK
| | - Marina Vasalaki
- Retinoblastoma Unit, Department of Ophthalmology, Royal London Hospital, Barts Health NHS Trust, London, UK
- The Western Eye Hospital, Marylebone, UK
| | - Khadija Rantell
- Education Unit, UCL Institute of Neurology, Queen Square, UK
| | - Mandeep S Sagoo
- Retinoblastoma Unit, Department of Ophthalmology, Royal London Hospital, Barts Health NHS Trust, London, UK
- Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - M Ashwin Reddy
- Retinoblastoma Unit, Department of Ophthalmology, Royal London Hospital, Barts Health NHS Trust, London, UK
- Moorfields Eye Hospital, London, UK
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Davis ME. Retinoblastoma: Making a Difference Together. Asia Pac J Oncol Nurs 2017; 4:181-183. [PMID: 28695161 PMCID: PMC5473086 DOI: 10.4103/apjon.apjon_33_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Mary Elizabeth is an Oncology Clinical Nurse Specialist from Memorial Sloan-Kettering Cancer Center in New York City, New York. She graduated from University of Delaware in 1985, with a Bachelor's degree in nursing and followed in 1989, with a Masters of Nursing from Columbia University specializing in oncology. Mary Elizabeth works as a Clinical Nurse Specialist in Memorial Sloan Kettering's ambulatory medical oncology consultative services. Her role includes modeling professional practice to the nurses of the services for which she has responsibility including mentoring and precepting nurses who are new to a practice, coordinating and evaluating their clinical experiences, and overseeing their development in the oncology nursing specialty and the ambulatory clinical practice role. Mary Elizabeth regularly “walks the walk” filling in and assisting in busy practices; this helps her maintain knowledge of the latest advances in disease management as well as experience firsthand the challenges of the ambulatory nursing role. Over the past few years, she has been practicing within MSK's busy and growing world - renowned retinoblastoma (RB) clinic. Mary Elizabeth has presented on RB nationally and at international conferences in the hopes of bringing this curable disease to the attention of nurses worldwide. Early diagnosis and early access to treatment can save lives, eyes, and vision.
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Liang Y, Chen X, Liang Z. MicroRNA-320 regulates autophagy in retinoblastoma by targeting hypoxia inducible factor-1α. Exp Ther Med 2017; 14:2367-2372. [PMID: 28962169 DOI: 10.3892/etm.2017.4779] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 05/11/2017] [Indexed: 12/28/2022] Open
Abstract
Retinoblastoma (RB) is the most common malignancy in children. Due to refractory mechanisms of chemoresistance and the toxicity of chemotherapies, novel therapies for RB treatment are urgently required. MicroRNA-320 (miR-320) is believed to be associated with the tumorigenesis of RB, although the mechanism remains unclear. Considering the hypoxic intratumoral region, the roles of miR-320 and hypoxia inducible factor-1α (HIF-1α) in the regulation of autophagy were investigated in 30 human RB samples and WERI-RB1 cells. The results demonstrated that HIF-1α was the downstream target of miR-320, and decreased miRNA-320 or HIF-1α lead to the inhibition of autophagy in WERI-RB1 cells. Compared with WERI-RB1 cells that were not transfected, silenced HIF-1α caused a 1.41-fold increase (P<0.01) in p62, a 2.71-fold decrease of Beclin1, and inhibited miRNA-320. Silenced HIF-1α also resulted in 7.29- and 7.43-fold increases in phosphorylated-mechanistic target of rapamycin (mTOR) and mTOR, respectively. In conclusion, the present results suggest that miRNA-320 may regulate the development of autophagy by targeting HIF-1α and autophagy-related proteins in RB under hypoxic conditions.
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Affiliation(s)
- Yong Liang
- Department of Ophthalmology, The Ninth People's Hospital of Chongqing, Chongqing 400700, P.R. China
| | - Xi Chen
- Department of Ophthalmology, The Ninth People's Hospital of Chongqing, Chongqing 400700, P.R. China
| | - Zhu Liang
- Department of Ophthalmology, The Ninth People's Hospital of Chongqing, Chongqing 400700, P.R. China
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Wang J, Xiang D. Early clinical characteristics of bacterial endophthalmitis in retinopathy of prematurity after intravitreal bevacizumab injection: A case report. Exp Ther Med 2017; 13:3563-3566. [PMID: 28588680 DOI: 10.3892/etm.2017.4406] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 02/14/2017] [Indexed: 01/20/2023] Open
Abstract
Intravitreal bevacizumab injection (IVB) is emerging as a safe and effective therapy for retinopathy of prematurity (ROP); however, follow-up investigations after IVB have indicated that endophthalmitis, a rare and devastating complication, may develop. The present study reports a case of an infant with ROP who developed endophthalmitis after IVB infection. The infant was administered with an intravitreal injection of broad-spectrum antibiotics to treat the endophthalmitis. A favorable anatomic outcome was achieved after follow-up. From this case, it was discovered that the early clinical characteristics of endophthalmitis infection secondary to IVB in premature infants include: i) The clinical symptoms of endophthalmitis infection appearing as early as 3-5 days after IVB; ii) a white membranous plaque on the retina surface with an obscure circular boundary; iii) a plaque that enlarges to a gray flocculent mass and intrudes the vitreous body, where the hazing surrounds the lesion; and iv) conjunctival hyperemia and cornea edema in the anterior segment of the affected eye. This case also indicated that timely retinal screening with RetCam or a binocular ophthalmoscope 3-5 days after IVB may be effective for detecting early stage endophthalmitis in infants who are unable to complain of a loss of visual acuity. From the present case report, it is advisable that the same type of screening be performed 3-5 days after other types of eye surgery, such as cataract extraction surgery, to detect early stage endophthalmitis. Furthermore, the present case also revealed that an early intravitreal injection of broad-spectrum antibiotics may be an effective treatment for premature infants with bacterial endophthalmitis.
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Affiliation(s)
- Jianxun Wang
- Department of Ophthalmology, Guangzhou Women and Children Medical Center, Guangzhou, Guangdong 510623, P.R. China
| | - Daoman Xiang
- Department of Ophthalmology, Guangzhou Women and Children Medical Center, Guangzhou, Guangdong 510623, P.R. China
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