WARNING: Very graphic photos at the end of this post! NOT FOR THE FAINT OF HEART!
The kid had undergone radiation by scleral (?) plaque and then actually had the left eye enucleated. What they do afterwards is implant a fake eyeball to keep the integrity of the orbit intact. I always thought that people with fake eyes just had this round ball put in with an iris and pupil painted on it. Actually the colored part is more like a giant scleral/contact lens. It goes over the actual fake globe. You pop off the lens to clean it, not the whole eyeball itself. (This is what the doctor told me, but anyone who knows otherwise please shed light on this topic). Up until around 2000, docs in China used fake globes made from CORAL of all things. This is because it is most similar to the composition of human bone and is less likely to be rejected by the host body. Now coral is no longer used but some type of plastic material instead. The surgeon will attach the muscles to the ball so that at least the eyes can move in synchrony. It is very difficult to do this properly so normally they will choose a ball that is larger than the child's original globe so that they don't have to change sizes/have another surgery as the kid grows.
In this kid's case, the globe part somehow came exposed through the conjunctival sac, so they had to go in and affix it properly to the muscles. This picture shows the sac area. I guess this is where you pop that lens part in for cosmesis. I don't know all the details too much bc I'm not in this rotation yet. At first I was told they were going to laser some retinoblastoma so upon first viewing the screen, I felt dumb because I couldn't figure out where the cornea was. They normally view through indirect and then laser it. Then I found out they had already enucleated the eye and were just doing repairs, so that explains why all I saw was a bloody pulpy looking mess.
We're just about finishing up our rotation through glaucoma. I feel like I can perform a trabeculectomy/filtering surgery now cuz it all starts to look the same after awhile. I kept forgetting to bring my camera those first few days but Jimmy has got some pretty cool pictures and even video footage.
Ready for prepping.
Prepped like a mummy and ready to go!
Here's a few photos I took in the surgical suite:
Ready for prepping. Prepped like a mummy and ready to go!Front row action--that's Jimmy's head up there. I couldn't get any actual pictures of the surgery bc the the glare of the light was really bad (though we could see perfectly) and I didn't want my annoying red target light thingy to be in the way of the doctor.
Random instrument I saw laying around in the suite. It looks like it's some type of hole punch for donor corneas...is my guess. It reminds me of those little hole punch things you use for arts and crafts that come in different cute shapes like butterflies and teddy bears.
*******WARNING IT GET'S NASTY****************
After the filtering surgery we heard there was some retinoblastoma sugery going on in suite 10 so I mosied on over. Of course, all the kids are always put under general anesthesia. All of the surgeries I've seen thus far are under local anesthesia. The patient's eyeball can move around but they don't feel any pain during the surgery.
The kid had undergone radiation by scleral (?) plaque and then actually had the left eye enucleated. What they do afterwards is implant a fake eyeball to keep the integrity of the orbit intact. I always thought that people with fake eyes just had this round ball put in with an iris and pupil painted on it. Actually the colored part is more like a giant scleral/contact lens. It goes over the actual fake globe. You pop off the lens to clean it, not the whole eyeball itself. (This is what the doctor told me, but anyone who knows otherwise please shed light on this topic). Up until around 2000, docs in China used fake globes made from CORAL of all things. This is because it is most similar to the composition of human bone and is less likely to be rejected by the host body. Now coral is no longer used but some type of plastic material instead. The surgeon will attach the muscles to the ball so that at least the eyes can move in synchrony. It is very difficult to do this properly so normally they will choose a ball that is larger than the child's original globe so that they don't have to change sizes/have another surgery as the kid grows.
4 comments:
So... Child with Retinoblastoma...
*they never penetrate the eye... b/c if there is a needle that penetrates an eye with Rb, wherever that needle touches, or exposes, the tumor can metastasize thru that portal to adjacent area*
if it's a small tumor: they can do laser, cryo, or chemotherapy. Chemo is done if it's macular, to preserve vision- but has an increased risk of recurrence.
if medium tumor: they can do Brachytherapy (radiation plaque... plaque is individually made per dimensions of the tumor, and then patient is admitted in hospital for 4 days...til radiation wears off - but has high risk of radiation retinopathy). Primary chemo (given thru IV). and External Beam Radiotherapy (this one causes bone malformation... so if you see a kid with a shrunken in facial bones... it's cuz as a child they had EBRT.)
if large tumor: chemo or enucleate the eye.
so... sounds like that kid had a large tumor of the left eye... and they implant that globe. They put the bigger ball in, so that the bony orbit will form to adult size so that the face won't be misshapen as an adult...
and the other eye had the brachytherapy... they put the plaque (which from work sounds like a metal plate) that they place on the sclera - over the area of where the tumor is... and the radiation seeps thru and kills the tumor..
Cool!!! I haven't gotten to see any surgeries yet. it just gets described and i see vids of it. but i haven't had a free day to go in and observe.
when you see an Rb patient on followup - they have to see the oncology ophthalmologist for life... You see the area where the plaque used to be - it'll look like a yellow-black chorioretinal scar, atrophies... vision is usually very decreased, and usually a strab. they get cataracts a lot quicker too, as children and get PCIOLs too... so many complications. and they have to be super careful to never penetrate that globe cuz if they do it can metastasize elsewhere.
and in the enucleated eye, they get mets thru the optic nerve and it ends up going to the brain and becomes a "trilateral" retinoblastoma.
Actually it was just unilateral. They did the brachytherapy first and I don't know what happened, maybe it didnt work and the tumor grew back so they had to enucleate.
I saw a post-op tumor patient at Fox. His retina was JACKED UP. And he basically came in for the referral to go see his oncologist person.
There's a lot of kiddies here with eye problems. They look so pitiful in their hella loose striped pjs and fox shields. :(
oh...... so u thought they were having brachy - and then they were actually having enucleation?
Yah retina's are jacked up... awww...
No they already had the brachytherapy, and it didn't work, so they enucleated (at some earlier point before this rotation). The glaucoma doctor I was following thought they were goin to laser the tumor but turns out the whole eye was already gone. The surgery was to repair some break in the conjunctival sac and secure the fake eyeball better.
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