RETINOBLASTOMA

- Routine eye examination (level 3 grade B) for infants and children EARLY DETECTION OF
LEUKOCORIA (WHITE PUPIL OR CAT’S EYE REFLEX and strabismus (squint)
- The most presenting sign of retinoblastoma – strabismus and leukocoria
- Most common intraocular tumor in childhood
- Majority diagnosed before 5yo
- 4 cases /mil states and Europe
- 2-6x higher in developing countries
- Early detection, one of most highly curable pediatric solid tumors
- Survival if early detection 90-95%
- Poor prognosis if beyond eye extent

Philippines

- 3rd most common malignancy in children <16yo

- Late diagnosis common
- Poorer prognosis
- Frequent cause of surgical enucleation in children 48-56% of children <12yo
- Leukocoria (most common presenting sign )77% filipino children ,56-62% of diagnosed cases of
retinoblastoma
- Strabismus - ocular misalignment , second most common sign, 20-24% of diagnosed cases, 11%
cases Filipino children
o Corneal reflex test – decentration of pupillary light reflex
o Simultaneous red reflex- helpful
o Cross cover test- more accurate in detect and characterized
-

Test

- No validation on accuracy and reliability of the eye examination since leukocoria and strabismus
can be seen in other ocular conditions
- Bruckner test
-

ASIa

- 11.1/ million cases <5yo Singapore

- 15% india
-

Benefit of screening

- Early detection and treatment

- Improved potential for preservation of vision
- Improved quality of life and overall survival

Treatment
 - Based on stage of disease
- Treatment options
o Laser therapy
o Focal radiation
o Freezing or heating treatments
o Chemotherapy for tumor reduction
o Enucleation – before primary treatment but now only considered when preservation of
vision is no longer possible

AAP recommendation

- All eye examination and vision assessment should be performed in the newborn period
- All well child visits
- All children to have found with ocular abnormalities or who fail vision assessment should be
referred to pediatric ophtha

Phil recommendation

- High risk for retinoblastoma

o Family history of disease
o Suspected based on family hx of surgical eye removal
o All children found w/ leukocoria and strabismus

Malignancy fairly developed over period of weeks from a small tumor treatable w/ focal salvaging
method to massive tumor that must be enucleated.

Bruckner test

- red reflex examination

- dark room, 12-18 inches away from eye with direct ophthalmoscope, 3 feet away (bright
reddish yellow and identical in both eyes, meaning symmetric)
- abnormal: dark spot in the reflex, blurred dull red reflex, white reflex –refer to pedia ophtha

Corneal light reflex

- light reflection from cornea

- penlight 2 feet in front of face
- child fixate on light
- normal: small white dot present symmetrically and located on center of both pupils
- abnormal: off center reflex or temporal displacement
- exotropic – eye moves inward, deviated outward
- esotropic- eye moves outward, deviated inward