Title : Pediatric bilateral retinoblastoma: Prosthetic challenges and solutions
Retinoblastoma is the second most common intraocular malignancy of infancy and early childhood. It develops due to the inheritance of a faulty gene RB1, incapable of suppressing the division of tumorous retinoblasts or an in-situ mutation of the same. Being a malignant neoplasm, it exhibits the tendency for both direct and metastatic spread, warranting a timely diagnosis and treatment to avoid drastic consequences of vision and eye loss. A total of 25%-35% of the cases present with cancerous involvement of both the eyes and optic nerves which if chemotherapeutically unresponsive, are managed with bilateral enucleations. The ambit of the functional and emotional deficits borne by such invasive procedures are vast and the ensuing handicap lends a crippling effect to the psychological status of the parents which needs to be handled urgently. Although the functional deficits are non-restorable but a prosthodontist can allay the anxiety and depression of the parents by addressing the aesthetic concerns in such cases with significant success. Bilateral ocular prosthesis fabricated, employing careful and deliberate techniques for alignment and shade matching lead to acceptable prosthetic outcomes. In this poster, two cases of bilateral enucleations are presented, one an infant and the other a child of seven years of age. The biggest challenge faced by the authors in this clinical scenario was the absence of a contralateral healthy eye to compare with and utilise as a landmark for iris alignment and shade matching. Facial landmarks and measurements were used to establish a basic level of symmetry using facial indexing technique and the shade selection was done using old photographs of the patients or by matching with parents. Another major difficulty was the tender age of these patients henceforth; both pharmacological and non-pharmacological ways were utilized for behaviour management. Using these approaches, the aesthetic profile of the patients was returned to near normal in a few days’ time leading to significant boost in the confidence levels of the primary caregivers. The children were also reported to mingle socially and keenly acquire education and skills to lead a normal life. Even more pleasing results can be achieved by employing the tool of digital photography. High resolution pictures taken of the iris prior to surgery can be printed to be used in the prosthesis lending elevated levels of clarity and duplication making the outcome increasingly pleasing.