The Global Retinoblastoma Outcome Study: a prospective, cluster-based analysis of 4064 patients from 149 countries

Background

Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival.

Methods

We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models.

Findings

The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope).

Interpretation

This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.

Funding

Queen Elizabeth Diamond Jubilee Trust.

AB0642 Diagnosis of Cerebral vasculitis: retrospective study of 68 cases

Background

Cerebral vasculitis, whether primary or secondary, is a group of heterogeneous pathologies characterized by a destructive inflammatory vascular wall lesion of the cerebral tissue. Its physiopathology remains poorly understood. Clinical polymorphism is a major characteristic of this disease.

Objectives

The aim of this work was to describe the epidemiological, clinical, radiological and etiological aspects of Cerebral vasculitis.

Methods

We conducted a retrospective descriptive study based of the records of 68 patients who were hospitalized in the Internal Medicine and Neurology Departments of the Taher Sfar University Hospital in Mahdia over a 12-year period from January 2008 to June 2021.

Results

A total of 68 patients were included: 46 female and 22 male (sex-ratio M/F: 0.47) with an average age of 50.8 ±12.7 [15-75 years]. The revealing symptoms were: Headaches in 52 patients (79.9%) followed by motor deficit in 21 patients (30.8%), sensitivity disorder in 24 patients (35.3%) and neurosensory disorders in 24 patients (35.3 %). These symptoms were insidious in 41 patients (61.2%). The neurological examination was pathological in 75 % of the patients, among them 19 patients (28.7%) had a walking disorder. Strokes were the revealing complication in 5 patients (7%).

Laboratory tests revealed an inflammatory syndrome in 37 patients (55.2%). The lumbar puncture was performed in 76.5% of cases. Cerebral spinal fluid showed aseptic meningitis in 5 cases and High protein level in 6 patients. The immunologic investigations showed that Antinuclear antibodies (ANA) were positive in 41 % and antiphospholipid antibodies were positive in 7.3%.

Cerebral Magnetic Resonance Imagining (MRI) revealed multiple patchy lesions hyperintense on T2 and FLAIR in the white matter in all cases: bilateral and asymmetric in 55 patients (80.9%) with subcortical distribution in 63% and periventricular localization in 45 %. Three patients had Leptomeningeal enhancement.

The etiologies of cerebral vasculitis were: Sjogren Syndrome in 33.8 %, Systemic lupus Erythematosus in 22%, Behcet disease in 19.1 %, Giant cell arteritis in 7.3%, antiphospholipid syndrome in 5.8%, Sarcoidosis in 4.4 %, Susac syndrome in 4.4 % and systemic sclerosis in 2.9 %.

Treatment was based on oral corticosteroids in 89.7 % of cases, associated with intravenous corticosteroids in 52.9% of cases. Immunosuppressive therapy was indicated in 42.4% of patients.

Prompt improvement was obtained in 48,3%, symptoms stability was noticed in 20 %. However, 30% of patients experienced relapse. Worsening of signs was seen in 1.7 %.

Conclusion

Cerebral vasculitis is a rare disorder with a non-specific clinical presentation. Therefore, its diagnosis is a challenge for clinicians who base their investigations on clinical and paraclinical arguments to attribute the neurological and systemic events to vasculitis. An early diagnosis and an appropriate treatment could improve its prognosis.

Disclosure of Interests

None declared

Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries

BACKGROUND

The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe.

METHODS

A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries.

RESULTS

Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease.

CONCLUSIONS

Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral.

Global Retinoblastoma Presentation and Analysis by National Income Level

Importance

Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale.

Objectives

To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis.

Design, Setting, and Participants

A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017.

Main Outcomes and Measures

Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis.

Results

The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]).

Conclusions and Relevance

This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs.

Hymenoptera insect stings: Ocular manifestations and management

PURPOSE

To describe the ocular findings and management of Hymenoptera insect stings.

METHODS

We treated and followed 8 patients with ocular Hymenoptera stings. All patients were admitted through emergencies and hospitalized at the Hedi Rays eye institute in Tunis.

RESULTS

The site of the sting was the cornea in 5 cases, limbus in one case, conjunctiva in one case and upper lid in the last case. Retained stingers were objectified in 4 cases. Immediate surgical extraction carried out in all cases. We also followed one case of post-sting Adie's syndrome and one case of retrobulbar optic neuritis. The sting was conjunctival in one case and palpebral in the other case. Corticosteroids were ineffective in these two cases.

CONCLUSION

Ocular Hymenoptera stings are rare environmental accidents. They may cause various severe ocular complications. Early management, adapted to the clinical manifestations, is the key to a good outcome.

Ligneous conjunctivitis due to plasminogen deficit: Diagnostic and therapeutic approach. With literature review

Ligneous conjunctivitis is a rare and poorly understood pathology. Infections and repeated microtraumas are often involved in acute disease flare-ups. This masquerade may lead to misdiagnosis and delayed treatment. We report two cases of ligneous conjunctivitis, describing various presentations of its natural history and focusing on the treatment of this rare disease.

Radiation Therapy for Primary Eyelid Cancers in Tunisia

Management of eyelid cancers is based on surgery and/or radiotherapy (RT). The treatment objective is to control tumors with acceptable functional and esthetic outcomes. The aim of this study was to evaluate the results of radiation therapy in management of epithelial eyelid cancers, reviewing retrospectively the clinical records of patients treated in our institution from January 1989 to December 2013. We focused on clinical and histological features, treatment characteristics, tolerance and disease control. One hundred and eight patients (62 men and 46 women) were enrolled, with a mean age of 61 years [ranges 1587]. The most frequent tumor location was the inner canthus (42.6%). Median tumor size was 21 mm [ranges 470]. Histological type was basal cell carcinoma in 88 cases (81.5%), squamous cell carcinoma in 16 (14.8%) and sebaceous carcinoma in 4 (3.7%). Radiation therapy was exclusive in 67 cases (62%) and postoperative for positive or close margins in the remaining cases. Kilovoltage external beam radiotherapy (KVRT) was used in 63 patients (58.3%) and lowdoserate interstitial brachytherapy in 37 (34.3%). Eight (7.4%) were treated with cobalt or with a combination of KVRTcobalt, KVRTelectron beams, KVRTbrachytherapy or cobaltelectron beams. The total delivered radiation doses were 70 Gy (2 Gy/fraction) in 62 patients (57.4%), 66 Gy (2 Gy/fraction) in 37 (34.3%) and 61.2 Gy (3.4Gy/fraction) in 9 (8.3%). After a median followup of 64 months, we noted 10 cases of local recurrences(9.2%): 7 after exclusive and 3 after postoperative RT. No local recurrence occurred in patients treated with brachytherapy. Actuarial 5year local recurrencefree rate, diseasefree survival and overall survival were respectively 90%, 90% and 97%. Tstage was found to be a significant factor for recurrence (p=0.047). All acute radiationrelated reactions were scored grade I or II. Delayed effects were eye watering in 24 cases (22.2%), eye dryness in 19 (17.6%), unilateral cataract in 7 (6.4%) and ectropion in 4 (3.7%). Radiation therapy and especially brachytherapy is an efficient treatment of eyelid cancers, allowing eye conservation and functional preservation with good local control rates and acceptable toxicity.

[Macula analysis by spectral domain OCT in rhegmatogenous retinal detachment surgery]

INTRODUCTION

Despite surgical reattachment of retinal layers, postoperative functional outcomes after rhegmatogenous retinal detachment (RRD) may be limited. This can be explained by microstructural changes in the macula inherent to the pathology itself as well as the surgery.

PURPOSE

To evaluate the various changes in the macula by OCT pre- and postoperatively, and correlate them with functional and clinical outcomes in patients with RRD. To establish pre- and postoperative prognostic factors.

METHODS

This was a prospective study of 50 eyes of 50 patients operated for RDD. Each patient underwent a complete clinical examination and macular OCT using the Heidelberg Spectralis; preoperatively and then successively at 7 days, 1 month, 3 months and 6 months after RRD surgery.

RESULTS

Preoperative tomographic results revealed an average height of submacular fluid of 742 ± 345 μm. Ninety-six percent of patients exhibited thickening of photoreceptor outer segments (PROS), 62% an outer layer undulation, 60% cystic cavities in the outer and/or inner nuclear layers (ONL, INL), 36% disruptions of the external limiting membrane (ELM) and 64% disruption of the IS/OS junction. Postoperatively, 24% of patients had persistent submacular fluid. The average thickness of the central fovea, the ONL, the IS/OS junction and the PROS were 172 ± 51.3 μm, 88.4 ± 30.9 μm, 11.36 ± 5.4 μm and 19.54 ± 13.1 μm respectively. Postoperative disruptions of the ELM, the IS/OS junction and Verhoeff's membrane (VM) were present in 24%, 60% and 82% of patients respectively. The preoperative tomographic risk factors for poor visual outcome were: submacular fluid height > 800 μm (P<0.001), disruptions of the MLE and/or IS/OS junction (P<0.001), as well as cystic cavities in the ENL and/or INL (P=0.002). Postoperative risk factors were: thinning of the fovea (≤ 250 μm), central fovea (≤ 160 μm), ONL (≤ 90 μm), IS/OS junction (≤ 10 μm) and PROS (≤ 18 μm) layers (P<0.001), as well as a discontinuous or absent appearance of the ELM (P<0.001), IS/OS junction (P<0.001) and VM (P=0.006).

CONCLUSION

Spectral domain OCT allows detection of specific microscopic, quasi-histologic macular changes in rhegmatogenous retinal detachment. These anomalies could be predictive of final postoperative visual outcome.

Mutation spectrum of RB1 gene in unilateral retinoblastoma cases from Tunisia and correlations with clinical features

Retinoblastoma, an embryonic neoplasm of retinal origin, is the most common primary intraocular malignancy in children. Somatic inactivation of both alleles of the RB1 tumor suppressor gene in a retinal progenitor cell through diverse mechanisms including genetic and epigenetic modifications, is the crucial event in initiation of tumorigenesis in most cases of isolated unilateral retinoblastoma. We analyzed DNA from tumor tissue and from peripheral blood to determine the RB1 mutation status and seek correlations with clinical features of 37 unrelated cases of Tunisian origin with sporadic retinoblastoma. All cases were unilateral except one who presented with bilateral disease, in whom no germline coding sequence alteration was identified. A multi-step mutation scanning protocol identified bi-allelic inactivation of RB1 gene in 30 (81%) of the samples tested. A total of 7 novel mutations were identified. There were three tumors without any detectable mutation while a subset contained multiple mutations in RB1 gene. The latter group included tumors collected after treatment with chemotherapy. There were seven individuals with germline mutations and all presented with advanced stage of tumor. There was no difference in age of onset of RB based on the germline mutation status. Thus 20% of the individuals with sporadic unilateral RB in this series carried germline mutations and indicate the importance of genetic testing all children with sporadic retinoblastoma. These findings help to characterize the spectrum of mutations present in the Tunisian population and can improve genetic diagnosis of retinoblastoma.

[Conjunctival limbal autograft versus simple excision with intra-operative mitomycin C in pterygium surgery: a comparative study]

PURPOSE

The purpose of our study is to evaluate the long-term anatomical and functional results of conjunctival-limbal autograft (AGCL) compared to simple excision with intraoperative mitomycin C.

PATIENTS AND METHODS

We conducted a prospective comparative study of 60 eyes of 60 patients presenting with primary pterygium. These patients were divided into two groups, matched according to the age and the stage of the pterygium. Thirty eyes of 30 patients were treated with conjunctival limbal autograft (AGCL group), and 30 eyes of the other 30 patients were treated with simple excision with intraoperative mitomycin C (MMC group). Minimum follow-up was 24 months.

RESULTS

The mean age of our patients was 50.6 and 51.3 years in the AGCL and MMC groups, respectively. A male predominance with male to female ratio of 1.5 was noted in both groups. We found more pterygium recurrences in the MMC group. Indeed, seven patients (23.3%) in the MMC group experienced a recurrence. In comparison, we found only a single recurrence (3.33%) in the AGCL group with a statistically significant difference (P=0.026). With regard to postoperative complications, we noted three inflammatory granulomas in the AGCL group (10%). In the MMC group, we observed two cases (6.66%) of delayed corneal healing with superficial punctate keratitis and epithelial defect and one case (3.33%) of symblepharon. There was no statistically significant difference in mean visual acuity gain between the two groups (AGCL: 1.76 lines; MMC: 2.82 lines; P=0.133).

CONCLUSION

Pterygium surgery by excision with conjunctival limbal autograft is an effective technique offering a low rate of long-term recurrences and few complications.

[Massive bilateral subconjunctival hemorrhage revealing acute lymphoblastic leukemia]

We report the case of 20-year-old patient who presented in emergency with bilateral massive, spontaneous subconjunctival hemorrhage. Clinical findings suggested a blood dyscrasia, which was confirmed by blood cell count. The patient was urgently referred to hematology where the diagnosis of acute lymphoblastic leukemia was made. This case highlights the importance of working up any unusual subconjunctival hemorrhage, as it may reveal, in certain cases, a severe life-threatening disease.

[MRI exploration for the evaluation of orbital implant biocolonization in children enucleated for retinoblastoma]

PURPOSE

To evaluate the contribution of MRI exploration for the evaluation of orbital prothesis biocolonization.

PATIENTS AND METHODS

We studied ten eyes of ten children who underwent enucleation for retinoblastoma and synthetic hydroxyapatite orbital implantation. Each patient was examined by MRI imaging with gadolinium within 2 months to 1 year.

RESULTS

After gadolinium administration, five implants showed an enhancement. Nodular enhancement around the implant was noted in one patient with a recurrence of retinoblastoma, and brain metastases were shown in two cases. None of the orbital implants was rejected.

CONCLUSION

Fibrovascular colonization reduces the risk of orbital implant migration. Magnetic resonance imaging is safe and effective in detecting extrusion or tolerance of the orbital implant.

[Ocular manifestations of diabetes: 285 cases]

BACKGROUND

Diabetes is one of the principal cause of blindness in adults. The aim of the study is to evaluate the frequency of ocular complications and risk factors of diabetes. It's a multicentric prospective study on a representative sample of 285 diabetics.

METHODS

We performed a general and an ophthalmologic exam for all patients with retinal angiography and appropriate laboratory tests. Chi 2, Fisher, Mann and Whitney tests were used as statistical methods.

RESULTS

Diabetic retinopathy was observed in 45,2% of patients, cataract in 22%, glaucoma in 5%. Diabetic retinopathy frequency rises especially with duration of diabetes and bad glycaemic control. Blindness related to diabetic retinopathy was observed in 6,25% and visual deficiency in 12,5%. The authors compared their results with literature data. They emphasize on the great value of regular better glycaemic control and other associated metabolic disorders.

CONCLUSION

We concluded that a regular ophthalmologic follow up is necessary for early diabetic retinopathy detection and treatment.

[Orbital hydatid cyst]

CASE

A 72-year-old man presented with left exophthalmia, impaired visual acuity and ocular pain. CT revealed a posterolateral homogeneous unilocular cyst in the left orbital cavity. Ultrasound showed a 38 x 17 mm purely cystic retro-ocular thin lined mass. Hydatid serologic tests were positive. The cyst was completely enucleated, after irrigation with hypertonic saline solution. The diagnosis was confirmed histologically.

DISCUSSION

The orbital hydatic cyst is a rare pathology in Western countries but remains relatively frequent in North-African countries. It can be observed in urban centers a high percentage of immigrant population. It is thus necessary to keep this pathology in mind when confronted to an intra-orbital cystic formation and to avoid its rupture.

[Clinical and progressive features of macular hemorrhage secondary to retinal artery macroaneurysms]

INTRODUCTION

Retinal arterial macroaneurysm (RAM) is an acquired vascular retinal abnormality that has developed from a retinal arterial branch located in the macular area. It is responsible for decreased visual acuity when complications such as bleeding or retinal exudation occur. A ruptured RAM leads to severe premacular, submacular, or vitreous hemorrhage. The progression can be spontaneously favorable depending on the severity and the location of the hemorrhage. A poor visual prognosis is usually reported in subretinal hemorrhage. We reported the observation of four patients with macular hemorrhage secondary to ruptured RAM.

PATIENTS AND METHODS

Four patients--two males and two females, aged from 39 to 65 years, presented with sudden unilateral decreased visual acuity. An ophthalmologic exam with visual acuity measurement, anterior segment exam, ocular tonometry, and funduscopy was performed, completed with fluorescein retinal angiography. A Nd:Yag laser hyaloidotomy was done in two cases of premacular hemorrhage 1 week after its occurrence. Submacular hemorrhages were only observed using visual acuity measurement and ophthalmoscopic examination. The follow-up is 3-4 months.

RESULTS

Initial visual acuity varied from light perception to 2/10. The fundus examination showed a macular hemorrhage: subretinal in one case, preretinal in two cases, and in the last case the hemorrhage was both preretinal and subretinal. The diagnosis of MAR was confirmed by fluorescein angiography, which showed a hyperfluorescent arterial dilatation temporal to the macula. In the cases of submacular hemorrhage, the hemorrhage reduced spontaneously after simple monitoring. Final visual acuity was 4/10 and 5/10. For premacular subhyaloid hemorrhage treated with laser Nd:Yag drainage, the final visual acuity was 5/10 and 7/10.

CONCLUSION

Visual prognosis in premacular hemorrhage is improved by Nd:Yag laser treatment. Subretinal hemorrhage can have a spontaneous favorable outcome. Surgery should not be systematic. Comparative studies are necessary to apply indications.

[Conjunctival dirofilariasis due to Dirofilaria Repens. A new Tunisian case]

INTRODUCTION

Dirofilariasis due to Dirofilaria repens is a parasitic disease affecting domestic animals and transmitted to man by mosquito bites. Human infestation is rare and involves benign subcutaneous and ocular manifestations. The diagnosis is made by excisional biopsy, which is also the sole recommended treatment. There are few reports of human infection in Tunisia.

CASE REPORT

We report herein the second case of conjunctival dirofilariasis in a 21-year-old woman residing in Tunis (Tunisia). The clinical presentation evoked orbital cellulites. Clinical and radiological investigations did not provide a diagnosis. Surgical excision and histological examination established the diagnosis by the presence of an adult female worm identified as Dirofilaria repens. Parasite extraction allowed successful treatment.

CONCLUSION

Dirofilariasis is rare in Tunisia, with only seven cases reported. The true incidence of dirofilariasis is probably greater than recognized. This can be explained by the apparent benign nature of the lesions that may not warrant excision.

[Prognosis of retinoblastoma. Report of 50 cases]

PURPOSE

The aim of this study was to analyze the factors influencing the prognosis of retinoblastoma.

MATERIALS AND METHODS

In 50 children with retinoblastoma, 69 eyes were reviewed. All patients had a full ophthalmic examination, a B-scan ultrasound, a computerized tomography scan and a pediatric examination. We performed enucleation in 47 eyes (with a histopathological study), external beam irradiation in 16 eyes, curitherapy in 4 eyes, cryotherapy in 3 eyes, and adjuvant chemotherapy in 7 cases.

RESULTS

The global survival rate was 87.5%. The main aggravating factors were: the size of the tumor and the extraretinal involvement with extension within the chroid, the sclera, and the optic nerve.

CONCLUSION

The prognosis of retinoblastoma mainly depends on the extraretinal invasion.