Retinoblastoma: diagnosis and management--the UK perspective

In the developed world, retinoblastoma is an uncommon yet highly curable ocular malignancy of childhood affecting 40-50 children in the UK each year. The presenting signs, most commonly leukocoria and squint, should alert the primary care physician or secondary care physician to examine for the red reflex, the absence of which is an indication for urgent ophthalmology assessment. Diagnosis is made by clinical examination and staging may include bone marrow sampling, lumbar puncture and MRI scanning. CT should be avoided to reduce radiation exposure in a population of whom a proportion are at considerable risk of second malignancies. Although enucleation is necessary for many children, over recent years there has been a growing emphasis on conservative management in an attempt to reduce the need for enucleation and avoid the adverse late effects associated with external beam radiotherapy. This review will describe approaches to treatment in the UK and how the stage, laterality and position of the tumour within the eye influence treatment choices.

Indocyanine Green-Enhanced Transpupillary Thermotherapy for Retinoblastoma: Analysis of 42 Tumors

PURPOSE

To evaluate the efficacy of indocyanine green-enhanced transpupillary thermotherapy (ICG-TTT) for retinoblastoma that shows suboptimal response to conventional treatments.

METHODS

A single center, retrospective chart review. The technique involved ICG infusion (range: 0.3 to 0.5 mg/kg) 1 minute prior to applying TTT using the indirect ophthalmoscope technique with a spot size of 1.2 mm.

RESULTS

There were 42 retinoblastomas in 30 eyes of 21 patients treated with ICG-TTT. The reasons for ICG enhancement included suboptimal response to standard TTT (n = 31, 74%), recurrence after standard TTT (n = 3, 7%), or minimally pigmented fundus with poor standard TTT uptake (n = 8, 19%). The mean patient age at treatment was 12 months (median: 11.6 months, range: 3 to 31 months). The mean tumor base was 3.5 mm (median: 3 mm), mean tumor thickness was 2.5 mm (median; 2 mm), mean distance to the foveola was 2.6 mm (median: 3 mm), and mean distance to the optic disc was 2.2 mm (median: 0.75 mm). Treatment parameters included a spot size of 1.2 mm, mean power of 760 mW (median: 800 mW, range: 400 to 1,200 mW), and mean duration of 4 minutes (median: 4 minutes, range: 0.5 to 14 minutes). Following a median of 2 sessions (range: 1 to 5 sessions) of ICG-TTT, 33 (79%) tumors demonstrated complete regression. The mean tumor thickness postoperatively was 1.7 mm. Two (5%) tumors showed minimal regression after ICG-TTT. During a mean follow-up of 46 months (median: 33 months), tumor recurrence after ICG-TTT developed in 7 (17%) cases at a mean interval of 7 months. Local complications of ICG-TTT included focal paraxial cataract (n = 2, 7%), iris atrophy (n = 1, 3%), and transient retinal hemorrhage (n = 2, 7%). Systemic problems included ICG allergy (n = 1, 5%). Overall, tumor control and globe salvage was achieved in all 30 (100%) eyes. There were no metastatic events.

CONCLUSIONS

ICG-TTT is an effective alternative for reti-noblastoma control, particularly for small tumors that show suboptimal response to standard

Socioeconomic and psychological impact of treatment for unilateral intraocular retinoblastoma

PURPOSE

To identify the socioeconomic and psychosocial impacts of clinical treatment decisions for advanced unilateral intraocular retinoblastoma.

DESIGN

Retrospective observational case series.

METHODS

SETTING

institutional study at Alexandria Main University Hospital.

STUDY POPULATION

records of 66 unilateral retinoblastoma cases treated from May 2005 to May 2013 were retrospectively reviewed. Sixty cases were eligible (International Intraocular Retinoblastoma Classification [IIRC] group C, D or E).

PROCEDURES

two treatment groups were compared: enucleation vs. salvage treatment. Salvage treatment eyes were further subdivided based on IIRC group. Six socioeconomic parameters (financial burden, financial impact, psychological, social, medical and tumor impacts) were scored. Parameter scores ranged from 0 to 3, for overall score range 0 (no adverse impact) to 18 (severe adverse impact).

MAIN OUTCOME MEASURES

derived Socioeconomic scores were correlated with treatment and outcomes.

RESULTS

The enucleation group (28 eyes) had a median overall Socioeconomic score of 4/18, significantly lower than the salvage treatment group (32 eyes), median score 11/18 (P<0.01). Socioeconomic score varied with IIRC group. Attempted eye salvage failed in 25 children, due to uncontrolled tumor (44%) and socioeconomic impact of cumulative therapies (56%). Treatment duration and Socioeconomic score were higher for the 5 children in the salvage treatment group who developed metastatic disease compared to those without metastasis (P<0.01).

CONCLUSIONS

The socioeconomic and psychosocial impacts of attempted ocular salvage for unilateral intraocular retinoblastoma are severe, in comparison to primary enucleation. Primary enucleation is a good treatment for unilateral retinoblastoma.

Clinical features and survival among children with retinoblastoma in Uganda

AIMS

To characterise the clinical features, treatment and outcome of children diagnosed with retinoblastoma in Uganda.

METHODS

The study comprised a 6-year nationwide enrolment with follow-up.

RESULTS

In total, 282 cases were enrolled, 26% (72) were bilateral; 6% were lost to follow-up. Almost all diagnoses in the first affected eye were International Classification of Retinoblastoma group E or worse. Histology was available for 92%; of those, 45%, had extraocular tumour at diagnosis. Enucleation of the first eye was done for 271; 94 received radiotherapy to the socket and in the last 2 years, 70 children received chemotherapy. At close of study, 139 children had died. Survival, as determined in a proportional hazards model adjusted for age, sex, laterality and treatment era (pre or post introduction of chemotherapy), varied by extent of the tumour (p<0.001); children with only intraocular involvement were 80% less likely to die (HR=0.21, 95% CI 0.12 to 0.35) compared with children with extraocular involvement.

CONCLUSIONS

Diagnostic delay results in relatively high mortality among children with retinoblastoma in Uganda. There is an urgent need for more effective treatment modalities, particularly chemotherapy, and nationwide efforts to encourage earlier access to medical care.

Retinoblastoma

Retinoblastoma is the most common neoplasm of the eye in childhood, and represents 3% of all childhood malignancies. Retinoblastoma is a cancer of the very young; two-thirds are diagnosed before 2 years of age and 95% before 5 years. Retinoblastoma presents in 2 distinct clinical forms: (1) a bilateral or multifocal, heritable form (25% of all cases), characterized by the presence of germline mutations of the RB1 gene; and (2) a unilateral or unifocal form (75% of all cases), 90% of which are nonhereditary. The treatment of retinoblastoma is multidisciplinary and is designed primarily to save life and preserve vision.

[Multidisciplinary management of retinoblastoma: Experience in 37 eyes]

OBJECTIVE

To report the results of the multidisciplinary management of patients with retinoblastoma, including survival, enucleation rate, and systemic chemoreduction success.

METHODS

A retrospective study was conducted on 27 patients (37 eyes) diagnosed with retinoblastoma, and treated by a multidisciplinary team in San Juan de Dios Hospital. Demographic information, clinical characterization, survival, local and systemic treatments were included in the analysis. Patients treated with intra-arterial chemotherapy (IAC) were also reviewed.

RESULTS

The study included14 male patients (52%). The median of age at presentation was 8 months (0.16-90). The median follow-up time was 33 ± 21 months. The diagnosis was made in 10 (37%) cases after 15 months old, with a median of 35 months (24-90). 17 (63%) patients had unilateral retinoblastoma, and 10 (37%) bilateral retinoblastoma. Leukocoria, isolated or associated with other signs, was the most frequent reason for referral (63%). Global enucleation rate was 57% (n=21), being the primary treatment in 15 (55%) patients. Enucleation rate in unilateral retinoblastoma was 76.5%, and for bilateral retinoblastoma, it was 60% for one eye and 10% for both. Systemic chemotherapy was prescribed in 17 (63%) patients, with a mean number of cycles of 5.3 ± 2.1. The overall success of chemoreduction and focal therapy in order to avoid external radiotherapy and/or enucleation was 68%. Three patients were treated with IAC as a salvage therapy, controlling the tumor in 2 patients at 6 months of follow-up. These are the first cases reported in Chile. Survival rate was 100%.

CONCLUSION

Multidisciplinary management of retinoblastoma led to a survival rate and morbidity comparable with international reports.

Bilateral diffuse uveal melanocytic proliferation with good clinical response to plasmapheresis and treatment of the primary tumor

PURPOSE

To report successful treatment of bilateral diffuse uveal melanocytic proliferation.

METHODS

Case report of a patient with clinical diagnosis of bilateral diffuse uveal melanocytic proliferation, imaged with fluorescein angiography and spectral domain optical coherence tomography, and with follow-up data after treatment with plasmapheresis, radiation, and chemotherapy.

RESULTS

A 67-year-old white man presented with a history of bilateral rapidly declining vision. The ophthalmoscopic examination, fluorescein angiography, and optical coherence tomography showed in both eyes an exudative retinal detachment and subretinal lesions highly suggestive for bilateral diffuse uveal melanocytic proliferation. Further investigation demonstrated a large cell lung carcinoma. Subsequently, the patient was treated with plasmapheresis, radiation, and chemotherapy. In a few weeks, the exudative retinal detachments resolved with gain of vision, and the retina remained flat during the 5-month follow-up.

CONCLUSION

Plasmapheresis and treatment of the primary tumor are valuable treatment options for visually impaired patients with bilateral diffuse uveal melanocytic proliferation.

[Available approaches to retinoblastoma therapy--literature review]

Retinoblastoma is a malignant tumor and treatment should be started as soon as possible. Currently, the most common approach combines local therapy with chemotherapy. Chemoreduction represents a significant advance in the treatment of retinoblastoma. This paper presents treatment approaches including local chemotherapy, intraarterial and intravitreous chemiotheraphy. retinoblastoma, chemotherapy chemoreduction, brachytherapy, thermotherapy, laser photocoagulation, proton radiotherapy, teleradiotherapy, intraarterial chemotherapy.

[Retinoblastoma: genetic background, modern diagnostic methods and therapies]

Retinoblastoma is the most common intraocular eye tumor of the pediatric age. It develops on account of a mutation on chromosome 13 in the 13q14 locus. New studies additionally demonstrated changes in the expression of other genes classified as oncogenes and suppressor genes. The tumor occurs in two forms--heritable (genetic) and non-heritable (non-genetic, sporadic). The most common clinical features of retinoblastoma are leucocoria and strabismus, however, they are not that specific because may also occur in several other eye diseases, such as Coats disease and toxocarosis. The diagnosis of retinoblastoma requires an indirect ophthalmoscopic examination. In addition, imaging techniques such as ultrasonography (USG), magnetic resonance imaging (MRI) and, less commonly, computer tomography (CT) are used. Biopsy is contraindicated because of the risk of spreading cancer cells to the adjacent tissues and possibility of a metastasis development. Currently, the stage of the disease and the therapy prognosis are classified by the International Intraocular Retinoblastoma Classification. At present, chemotherapy is the standard treatment of retinoblastoma. During the last decades new therapies have been introduced, such as transpupillary thermotherapy (TTT), cryotherapy, brachytherapy, limiting the use of teletherapy and the number of performed enucleations. Patients with therapy-induced remission of retinoblastoma should undergo routine examinations because of the increased risk of subsequent neoplasms and other possible complications.

Retinoblastoma. Fifty years of progress. The LXXI Edward Jackson Memorial Lecture

PURPOSE

To review the progress made in understanding the genetic basis, molecular pathology, and treatment of retinoblastoma since the previous Jackson lecture on the topic was published 50 years ago.

DESIGN

Perspective based on personal experience and the literature.

METHODS

The literature regarding retinoblastoma was reviewed since 1963. Advances in understanding the biology and treatment of retinoblastoma provided context through the author's clinical, pathologic, and research experiences.

RESULTS

Retinoblastoma was first identified in the 1500s and defined as a unique clinicopathologic entity in 1809. Until the mid-1900s, knowledge advanced sporadically, with technological developments of ophthalmoscopy and light microscopy, and with the introduction of surgical enucleation, chemotherapy, and radiation therapy. During the last 50 years, research and treatment have progressed at an unprecedented rate owing to innovations in molecular biology and the development of targeted therapies. During this time period, the retinoblastoma gene was discovered; techniques for genetic testing for retinoblastoma were developed; and plaque brachytherapy, chemoreduction, intra-arterial chemotherapy, and intraocular injections of chemotherapeutic agents were successfully introduced.

CONCLUSIONS

Nearly all patients with retinoblastoma in developed countries can now be cured of their primary cancer--a remarkable achievement for a childhood cancer that once was uniformly fatal. Much of this success is owed to deciphering the role of the Rb gene, and the benefits of targeted therapies, such as chemoreduction with consolidation as well as intra-arterial and intravitreal chemotherapies. Going forward, the main challenge will be ensuring that access to care is available for all children, particularly those in developing countries.

[Retinoblastoma spontaneous regression: clinical and histopathologic analysis]

OBJECTIVE

To analyze the clinicopathologic characteristics of retinoblastoma spontaneous regression.

METHODS

Retrospective case series study. The clinic and pathologic data of 52 cases of retinoblastoma spontaneous regression were analyzed retrospectively. All the cases came from 579 cases of retinoblastoma (without pre-enucleation chemotherapy) archived in Ophthalmic Pathology Laboratory of Beijing Tongren Eye Centre from Jan. 2007 to Dec. 2013. The analyzed factors included tumor activity, tumor invasion, and tissue changes of uveal and lens.

RESULTS

In this study, the patients' average age was (14.0 ± 8.7) months. There were 33 (63.5%) male and 19 (36.5%) female patients. The rate of retinoblastoma spontaneous regression was 9.0% (52/579), of which the rate of complete regression was 1.4% (8/579). The most common symptom was leucocoria coupled with red eye 55.8% (29/52). The typical clinicopathologic characteristics were as follows: (1) all or most of all tumor cells suffered coagulation necrosis and only tumor cell remains were left; (2)most eyeballs showed atrophiabulbi or phthisis bulbi; (3) severe atrophy occurred in uvea, especially in iris and ciliary body combined with pigment cells disintegrating; (4) cataract formed coupled with lens swelling, displacement, or wrapped by fibrous connective tissue; (5) in a small number of cases, there were alive tumor cells in the retrolaminar optic nerve or choroid in spite of most tumor cells had suffered regression, indicating the patients had histopathologic high risk factors and had the dispositions of tumor diffusion and metastasis.

CONCLUSIONS

Some untypical clinical manifestation such as leukocoria coupled with red eye or atrophia bulbi should be paid close attention. The possibility of retinoblastoma spontaneous regression should be considered. Meanwhile, some cases of retinoblastoma spontaneous regression with histopathologic high risk factors should be given post-enucleation systemic adjuvant chemotherapy combined with close observations and follow-ups.

[Research advances of animal models of retinoblastoma]

Advances in animal models of retinoblastoma have accelerated the research in understanding tumor biology and assessing therapeutic modalities. At present, there are two types of models:transgenic models and xenograft models. The transgenic models have experienced a developmental process from LH-β-Tag models to conditional gene knock-out models. The xenograft models included intraocular transplantation models and subcutaneous transplantation models. The two types of RB models both have their merits and drawbacks. The combination of genetic and xenograft models in retinoblastoma research has and will help to pave way for better understanding tumor progression and searching more effective diagnosis and treatment modalities. In this review, we summarized the recent research progress in animal models of retinoblastoma and their application in assessing therapeutic modalities.

Immunohistochemical expression of CD117 and vascular endothelial growth factor in retinoblastoma: possible targets of new therapies

CD117 (C-kit) is thought to play an important role in tumourigenesis. There are limited data in the literature concerning C-kit expression in retinoblastoma. To date, no immunohistochemical studies have been performed to assess the possible association of C-kit with vascular endothelial growth factor (VEGF) in retinoblastoma. This study was designed to investigate C-kit and VEGF immunoexpression in retinoblastoma, their relationship with prognostic parameters as well as the correlation between them. A prospective immunohistochemical study was conducted on 56 retinoblastoma cases. Patients who had received preoperative chemotherapy were excluded. Positive C-kit and VEGF immunoreactivity was observed in 48.2% and 76.8% of retinoblastoma cases respectively. No C-kit immunostaining was seen in the adjacent uninvolved retina. However, VEGF expression was detected within its vasculature. Retinoblastomas with combined pattern of tumour growth revealed a highly significant positive C-kit expression (P = 0.002) compared to cases with endophytic or exophytic growths. Also, positive C-kit expression was statistically higher in cases with optic nerve invasion (P = 0.001) and choroidal invasion (P ≤ 0.01) compared to negative cases. A highly significant positive VEGF expression was detected in cases with optic nerve invasion (P = 0.013) compared to negative cases. Moreover, a highly significant positive correlation was detected between C-kit and VEGF expression (P = 0.006). C-kit is a feature of more aggressive retinoblastomas, with increased expression in tumours spreading beyond the retina. Moreover, VEGF is vastly expressed in retinoblastoma and is associated with optic nerve invasion. Both C-kit and VEGF may represent potential therapeutic targets for retinoblastomas.

Clinical manifestations and treatment of retinoblastoma in Kobe children's hospital for 16 years

PURPOSE

To report the clinical manifestations and therapeutic outcomes of retinoblastoma during 16 years.

METHODS

Forty-three eyes of 34 patients with retinoblastoma from 1996 to 2011 were retrospectively examined for eye preservation rates based on the disease stage, and the treatment outcomes between monocular and binocular cases were compared. In addition, the relationship between age at initial examination and disease stage and the difference of age at enucleation with or without preservation therapy were examined.

RESULTS

Twenty-five patients had monocular retinoblastoma and 9 patients had binocular retinoblastoma. Three patients had a family history of retinoblastoma. The mean observation period was 106.6 ± 53.0 months. Median age at initial examination was 13.5 months. There was no correlation between age at initial examination and disease stage. Preservation therapy was performed for 24 eyes. Nineteen eyes were enucleated without performing preservation therapy. There was a significant difference in age at enucleation between the preservation therapy group (finally enucleated 13 eyes, median = 30.0 months) and the non-preservation therapy group (19 eyes, median = 13.0 months). Eye preservation rates according to the International Classification of Retinoblastoma (ICRB) were as follows: 100% for group B, 100% for group C, 33% for group D, and 0% for group E. In eyes with ICRB group D, the ratio of induction with preservation therapy was 50% of monocular cases and 75% of binocular cases.

CONCLUSIONS

Preservation therapy was able to significantly delay enucleation. Eye preservation therapy was performed for a higher proportion of advanced cases among binocular cases than among monocular cases.

[Combined transscleral and transpupillary thermotherapy in large vasoproliferative retinal tumors]

Three cases (two patients) of large vasoproliferative retinal tumor treatment by an original method, which includes intraoperative non-contact transscleral thermotherapy and subsequent transpupillary thermotherapy, are described. Positive anatomical results were achieved in all three cases.

Inhibition of polo-like kinase 1 promotes hyperthermia sensitivity via inactivation of heat shock transcription factor 1 in human retinoblastoma cells

PURPOSE

Hyperthermia (HT) has been recognized as an effective focal treatment in retinoblastoma. However, one of the problems with HT therapy is that cells acquire acquisition. The purpose of this study was to evaluate whether the inhibition of polo-like kinase 1 (PLK1) would promote HT sensitivity in human retinoblastoma cells.

METHODS

We examined the effects of PLK1 knockdown by small interfering RNA (siRNA) or by the inhibition of PLK1 activity with PLK1 inhibitor (BI-2536) on the sensitivity to HT (44°C, 1 hour) in human retinoblastoma Y79 and WERI-Rb-1 cells by evaluating apoptosis and cell proliferation using flow cytometry, Western blotting, real-time quantitative polymerase chain reaction, and WST-8 assay. Furthermore, we investigated the effects of activating heat shock transcription factor 1 (HSF1) through a combination of PLK1 knockdown and HT using Western blotting and immunocytochemistry.

RESULTS

The combination of PLK1 inhibition and HT enhanced sensitivity to HT synergistically. Furthermore, PLK1 knockdown inhibited HT-induced phosphorylation of HSF1, the nuclear translocation of HSF1 from the cytoplasm, and nuclear granule formation of HSF1. Heat shock transcription factor 1, inactivated by the silencing of PLK1, reduced the expression of heat shock proteins (HSPs), such as HSP70 and HSP40, as well as the expression of Bcl-2-associated athanogene 3 (BAG3).

CONCLUSIONS

Polo-like kinase 1 inhibition may attenuate the thermoresistance of HT through the inactivation of HSF1 concomitant with reductions in HSPs and BAG3. The combination of PLK1 inhibition and HT may become an option for HT therapy in patients with retinoblastoma.

Colorimetric and longitudinal analysis of leukocoria in recreational photographs of children with retinoblastoma

Retinoblastoma is the most common primary intraocular tumor in children. The first sign that is often reported by parents is the appearance of recurrent leukocoria (i.e., "white eye") in recreational photographs. A quantitative definition or scale of leukocoria--as it appears during recreational photography--has not been established, and the amount of clinical information contained in a leukocoric image (collected by a parent) remains unknown. Moreover, the hypothesis that photographic leukocoria can be a sign of early stage retinoblastoma has not been tested for even a single patient. This study used commercially available software (Adobe Photoshop®) and standard color space conversion algorithms (operable in Microsoft Excel®) to quantify leukocoria in actual "baby pictures" of 9 children with retinoblastoma (that were collected by parents during recreational activities i.e., in nonclinical settings). One particular patient with bilateral retinoblastoma ("Patient Zero") was photographed >7, 000 times by his parents (who are authors of this study) over three years: from birth, through diagnosis, treatment, and remission. This large set of photographs allowed us to determine the longitudinal and lateral frequency of leukocoria throughout the patient's life. This study establishes: (i) that leukocoria can emerge at a low frequency in early-stage retinoblastoma and increase in frequency during disease progression, but decrease upon disease regression, (ii) that Hue, Saturation and Value (i.e., HSV color space) are suitable metrics for quantifying the intensity of retinoblastoma-linked leukocoria; (iii) that different sets of intraocular retinoblastoma tumors can produce distinct leukocoric reflections; and (iv) the Saturation-Value plane of HSV color space represents a convenient scale for quantifying and classifying pupillary reflections as they appear during recreational photography.

Retinoblastoma in Turkey: results from a tertiary care center in Ankara

PURPOSE

To evaluate the presentation patterns and results of management of retinoblastoma at a tertiary care center in Ankara, Turkey, with special emphasis on globe conservation rate in unilateral and bilateral intraocular retinoblastoma.

METHODS

Patients were grouped according to the International Classification of Retinoblastoma. For intraocular retinoblastoma, group E and some group D eyes underwent primary enucleation. Secondary enucleation was performed after failure of chemoreduction, focal treatments, external beam radiotherapy (EBRT), and intra-arterial chemotherapy used in various combinations. For extraocular retinoblastoma cases, treatment consisted of enucleation/exenteration or orbital biopsy, high-dose chemotherapy, and EBRT to the orbit and metastatic sites.

RESULTS

During the study period from October 1998 to May 2010, 165 of 192 (85.9%) patients had intraocular disease and 27 (14.1%) patients had extraocular disease. In total, primary or secondary enucleation was performed in 70 of 94 eyes with unilateral retinoblastoma (74.5%) and in 34 of 142 eyes with bilateral retinoblastoma (23.9%). The overall globe conservation rate was 69.6%. Only one patient in the intraocular retinoblastoma group died of metastatic retinoblastoma to the central nervous system. Twenty of 27 patients (74.1%) with extraocular retinoblastoma were found to have metastasis to the central nervous system, bone, bone marrow, and/or lymph nodes. At a mean follow-up of 28.0 months (median: 12 months; range: 1 to 120 months), survival was 33.3% despite intensive treatment.

CONCLUSIONS

The overall risk of enucleation was 75% in eyes with unilateral retinoblastoma and 24% in eyes with bilateral retinoblastoma. Extraocular retinoblastoma carries a 75% risk of systemic metastasis and 67% risk of death.

Retinoblastoma detected by preschool vision screening using visual-evoked potentials

Two cases of otherwise healthy children with no known family history of retinoblastoma who were diagnosed as having retinoblastoma after failing a visual-evoked potential test during a well-child visit are reported. This early detection allowed for eye-sparing treatment.

Retinoblastoma presenting with orbital cellulitis

PURPOSE

To study the effectiveness of pre-enucleation steroids in reducing inflammation in patients with retinoblastoma presenting as orbital cellulitis.

METHODS

Medical records of consecutive retinoblastoma patients presenting at a single tertiary eye care center during a period of 3 years were retrospectively reviewed. For those who presented with orbital cellulitis, clinical, radiological, and histopathological variables were assessed. The effect of pre-enucleation steroids was noted in this group of patients.

RESULTS

Of 260 retinoblastoma cases reviewed, 14 had retinoblastoma-associated cellulitis (5.39%). Of these 14 patients, 4 received neoadjuvant chemotherapy and were excluded from the series. Of the remaining 10 cases (mean age at presentation, 14.2 months; mean follow-up, 16.4 months), 9 presented with orbital cellulitis and were included in the study. Radiological imaging depicted intraocular tumors occupying 80% to 100% of the globe in each case. All patients underwent enucleation. Five children received pre-enucleation systemic steroids (mean, 5.4 days), which resulted in a prompt decrease in inflammation. Postenucleation chemotherapy was administered in 4 (6 cycles) and external beam radiation therapy in 1 patient with high-risk histopathological characteristics.

CONCLUSIONS

Advanced necrotic retinoblastoma with anterior segment involvement may present as orbital cellulitis. Pre-enucleation systemic steroids can aid in the surgical management of these tumors.