Philippine retinoblastoma initiative multi-eye center study 2010-2020.

AIM: To provide a comprehensive and more representative national data on the disease, especially on treatment options and outcomes, and to determine access of retinoblastoma patients from Luzon, Visayas and Mindanao to eye care, and determine if access is associated with delay in consultation, staging and outcomes. METHODS: Cohort study of retinoblastoma patients seen in eleven institutions located in the three major areas of the Philippines namely Luzon, Vizayas and Mindanao from 2010-2020. RESULTS: Totally 636 patients, involving 821 eyes, were included. Majority (57%) were from Luzon and were seen in institutions in Luzon (72%). Annually, 58±10 new cases were seen with 71% having unilateral disease. Median delay of consultation remained long at 9 (3, 17)mo, longest in patients with unilateral disease (P<0.02) and those from the Visayas (P<0.003). Based on the International Retinoblastoma Staging System, only 35% of patients had Stage 1 while 47% already had extraocular disease. Enucleation was the most common treatment received by 484 patients while intravenous chemotherapy was received by 469. There were 250 (39%) patients alive, 195 (31%) dead, 85 (13%) abandoned, 17 (3%) refused and 89 (14%) with no data. CONCLUSION: This study presents the largest cohort of retinoblastoma patients in the Philippines in terms of patients' and participating institutions' number and geographical location and type of institution (private and public). It also presents more comprehensive data on the treatments used and outcomes (survival, globe salvage, and vision retention rates). Delay in consultation was still long among patients leading to advanced disease stage and lower survival rate. Despite increasing capacity to diagnose and manage retinoblastoma in the country, the delay of consultation remains long primarily due to accessibility issues to eye care institutions especially in the Visayas and financial concerns. The delay was still significant that overall survival rate remain low.

Acute angle closure glaucoma from spontaneous massive subretinal hemorrhage.

Purpose: To report a case of acute angle closure glaucoma from spontaneous massive hemorrhagic retinal detachment from hypertension and diabetes mellitus. Methods: A 52-year-old woman with controlled systemic hypertension and newly diagnosed diabetes mellitus presented with sudden onset painful loss of vision of the right eye. Examination of the right eye showed no light perception, an intraocular pressure of 60 with shallow anterior chamber, microystic corneal edema, closed angles on gonioscopy, and massive subretinal hemorrhage on indirect ophthalmoscopy. The left eye was essentially normal except for arterio-venous crossing changes. Ocular ultrasound revealed massive subretinal hemorrhage with possible intraocular mass. Enucleation of the painful blind eye was done for histologic diagnosis. Results: The ocular pathology revealed complete angle closure with total retinal detachment from massive subretinal hemorrhage with no mass or tumor seen. Metastatic work-up included liver enzymes, mammography, transvaginal ultrasound, chest radiography, and cranial and abdominal computerized tomography which were all normal. Conclusion: Hypertension and diabetes mellitus may cause spontaneous massive subretinal hemorrhagic retinal detachment resulting in secondary angle closure glaucoma. Enucleation is a therapeutic option if a suspicion of an intraocular tumor is present.

Psychosocial Factors Influencing Parental Decision to Allow or Refuse Potentially Lifesaving Enucleation in Children with Retinoblastoma.

OBJECTIVE: Retinoblastoma is the most common malignancy of the eye and ocular adnexa in the Philippines. It is curable when treated early, but delay in enucleation is common due to the parental refusal of surgery for varied reasons. The aim of this study is to identify the psychosocial barriers and facilitating factors for accepting versus refusing enucleation as treatment for retinoblastoma. METHODS: This is a cross-sectional descriptive study utilizing structured interviews and a questionnaire. It was conducted at the Retinoblastoma Clinic of the Philippine General Hospital. A questionnaire using the Likert scale was constructed after performing key informant interviews and focus group discussions. It was pretested and revised before parents of patients with retinoblastoma were invited to participate in the study. Descriptive statistics, quantitative item analyses using inter-item correlations and item-total correlations was performed. RESULTS: Factors that correlate with refusal to enucleate are the beliefs that cancer is a fatal illness, the fear of unacceptable esthetic outcome of the surgery, and the cost of treatment. Favorable factors include value of life, high regard for the opinion of medical practitioners, and appreciation of the efficacy of treatment. CONCLUSIONS: There are several favorable factors and barriers that health practitioners must consider in facilitating parental decision-making toward enucleation for retinoblastoma.

Tumors of the eye and ocular adnexa at the Philippine Eye Research Institute: a 10-year review.

OBJECTIVE: We aimed to identify and describe the clinicopathologic characteristics of tumors of the eye and ocular adnexa at the Philippine Eye Research Institute. METHODS: The pathology reports of specimens submitted to the Ocular Pathology Section of the Philippine Eye Research Institute over a 10-year period (2003-2012) were reviewed, and collected data was subjected to descriptive statistical tabulation and analysis. RESULTS: A total of 1,551 histologically confirmed tumors were included. Of these, 254 were from the conjunctiva (155 benign, 99 malignant), 530 from the eyelids (360 benign, 170 malignant), 394 were intraocular tumors (21 benign, 373 malignant), and 373 were from the orbit (231 benign, 142 malignant). Retinoblastoma was the most common tumor of the eye and ocular adnexa in the series, accounting for 43.2% of all malignancies. Squamous cell carcinoma was the most frequent cancer of the conjunctiva, while basal cell carcinoma and sebaceous gland carcinoma were the most common eyelid malignancies. Orbital malignancies had a bimodal age distribution, with rhabdomyosarcoma being most frequent in children, while in adults, lymphoma was most common, followed by lacrimal gland carcinomas. CONCLUSION: The majority of tumors of the conjunctiva, eyelids, and orbit were benign, while most intraocular tumors were malignant, with retinoblastoma being the most common.