Clinical pattern of Retinoblastoma in Pakistani population: Review of 403 eyes in 295 patients.

OBJECTIVE: To document clinical pattern of retinoblastoma in Pakistani population. METHODS: This retrospective study, which was conducted at Department of Ophthalmology, Dow University of Health Sciences, Karachi, reviewed clinical records of patients with retinoblastoma from 1997 to 2012. Staging of disease was done by referring to retinal diagrams, RetCam images, and first magnetic resonance imaging. Ophthalmic notes, imaging reports and histopathology reports of enucleated eyes established optic nerve involvement. SPSS 21 was used for statistical analysis. RESULTS: Clinical records of 295 patients with retinoblastoma in 403 eyes were reviewed, and male to female ratio was 1.3:1. Retinoblastoma was bilateral in 106(35.93%) patients, while 118(40%) patients had hereditary pattern. Mean age at presentation was 35.98+27.63 months, while mean follow-up was 3±2 months. Leucokoria was the most common presenting feature 173(58.64%) followed by proptosis 72(24.41%). Optic nerve involvement was seen on magnetic resonance imaging or histopathology in 81(20.10%) eyes. Distant metastasis was noted in 32(10.85%) patients on first presentation. Chemotherapy with or without adjuvant treatment was given to 238(80.68%) patients. Enucleation and exentration were performed in 164(40.69%) and 12(2.98%) eyes, respectively. CONCLUSIONS: Most common presenting symptom was leucokoria followed by proptosis. Hereditary retinoblastoma was frequently seen in Pakistani children. .

Outcome of focal treatment to residual retinoblastoma after chemotherapy (Experience with Focal Treatment of Retinoblastoma).

We report a prospective case series on the anatomical, and functional outcomes, and complications of focal treatment of retinoblastoma to residual tumors in patients who had already received chemotherapy. We examined the patients of retinoblastoma under general anaesthesia with Ret Cam II. Patients with lesions from Group 1 to Group 5 of Reese Ellsworth classification at presentation. They were first given chemotherapy according to VEC (Vincristine, Etoposide and Carboplatin) protocol and then focal treatment. Solid State Green laser photocoagulation and/or cryotherapy were applied to the lesions with help of indirect ophthalmoscope. Thirty one eyes of 26 children were treated. The mean age at presentation was 35.5 ± 6.4 (median = 24, IQR = 36) months. Fourteen (57.7%) were male and 12 (42.3%) were female. Twenty three (88.5%) children had bilateral retinoblastoma and 3 (11.5%) had unilateral involvement. Complete regression was achieved in 25 (80.6%) eyes. Only 6 (19.4%) eyes had to be enucleated. Final mean LogMAR visual acuity after treatment was0.6 ± 0.64. Transient Corneal oedema was the most commonly observed adverse effect seen immediately after laser photocoagulation in 12 (38.7%) eyes. Focal treatment is a good and effective adjuvant to systemic treatment and ophthalmologists should be aware of this modality of treatment and competent enough to use these modalities appropriately to improve the outcome of RB patients in our population.