Surgery for Retinoblastoma

Enucleation consists of the surgical removal of the eye and a portion of the optic nerve behind it, and it was once the standard of care for advanced retinoblastoma . At our center, enucleation is now performed only rarely, since it has been largely replace by super-selective intra-arterial chemotherapy.

Enucleation is most often recommended for those patients who have already lost vision in the affected eye or whose advanced cancer is life threatening. The surgery is brief, painless, and is performed under general anesthesia as an outpatient.

During the enucleation procedure, the eyeball is replaced with an implant of the same size and shape; it is attached to the muscles to allow it to move in synch with the other eye. Later, the implant is fitted with a special covering to make it look like the other eye and achieve a relatively normal appearance.

As emotionally difficult as enucleation may be, it is extremely effective in preventing the spread of cancer to the brain or to other parts of the body — it can be life-saving. Enucleation may be preferred in the following circumstances:

• The size of the tumor(s): If a large tumor or tumors fill most of the eye
• The patient’s existing vision: If the eye has already lost all sight
• The extent of the cancer: If the tumor has spread outside the eye or to the optic nerve
• Failure of all other treatments.

Enucleation is never an easy choice, but it is an extremely effective way to cure the child of retinoblastoma and prevent spread of the cancer. When possible, doctors consider eye-saving treatments, including the new intra-arterial chemotherapy for retinoblastoma.

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