Orbital Complications and Cost Analysis of Enucleation by Myoconjunctival versus Conventional Techniques for Retinoblastoma.

Autor:	Lando L; Department of Ophthalmology and Visual Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Canada.; Department of Ophthalmology and Visual Sciences, The Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Canada.; Ocular Oncology Service, Barretos Cancer Hospital, Barretos, Brazil., Mallipatna A; Department of Ophthalmology and Visual Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Canada., Kletke SN; Department of Ophthalmology and Visual Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Canada., Gallie B; Department of Ophthalmology and Visual Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
Jazyk:	angličtina
Zdroj:	Ocular oncology and pathology [Ocul Oncol Pathol] 2023 Dec; Vol. 9 (5-6), pp. 123-129. Date of Electronic Publication: 2023 Jul 20.
DOI:	10.1159/000531871
Abstrakt:	Introduction: The aim of the study was to compare complication rates and hospital costs of myoconjunctival versus conventional enucleation techniques in retinoblastoma. Methods: This retrospective cohort and cost analysis reviewed patients with retinoblastoma treated by primary or secondary enucleation between 2003 and 2021 and a minimum 6-month follow-up. Cases were reviewed for three postsurgical complications: chronic conjunctivitis, implant exposure/extrusion, and cellulitis. Cases were excluded if surgery was performed elsewhere or documentation was incomplete. Treatment costs were estimated based on two sample cases billed in 2021 that manifested the studied complications and represented each of the two surgical techniques. Univariate and multivariate analyses were applied to compare complication rates and treatment costs. Results: Included were 180 eyes (179 patients); 239 eyes (227 patients) were excluded. Patients had median age of 18.9 (0-104.4) months at diagnosis, the majority were male (94, 52%), with unilateral (115, 64%) group D or E (163, 91%) eyes. Enucleation was performed by conventional techniques in 107 eyes (59%) and by myoconjunctival approach in 73 (41%). Orbital complications occurred in 61 eyes (34%) during a median follow-up of 7.9 (0.5-33.7) years, more frequently in the conventional technique group ( p = 0.014). The myoconjunctival technique had significantly lower costs for implant price ( p < 0.001) and estimated treatment cost, including complication management ( p < 0.001). Conclusion: Enucleation by myoconjunctival technique showed significantly less complication burden and treatment cost, indicating advantages over conventional approaches. Study limitations include the retrospective nature, confounders' complexity, and follow-up time variations. Competing Interests: None of the authors report any conflict of interest related to this study. Leonardo Lando reports past grants by the Pan-American Association of Ophthalmology (Sear Scholarship, 2019–2020) and the International Society of Ocular Oncology (ISOO, 2022). (© 2023 S. Karger AG, Basel.)
Databáze:	MEDLINE
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