February, 2020

CASE #1

• NAME :Mudassir
• AGE :4.2 yrs
• P/C : Right eye deviation since age of 1 ½ years
• H/O CANCER IN FAMILY : No
• DIAGNOSIS: Bilateral retinoblastoma
• Right eye: Group D
• Left eye : Group C
R-Group D , L-Group C 1st EUA AUG’2019
AUG’2019
AUG’2019
October’2019 EUA
October’2019
October’2019
October’2019
November, 2019 EUA
November, 2019
LATEST JANUARY 2020 EUA
LATEST JANUARY 2020
LATEST JANUARY 2020
Most recent EUGA shows all lesions better in
Right eye (Inactive)

Left eye lesion also much resolved with minimal

SRF inferiorly

Alhumdullilah.
 CASE #2

• NAME :Abdullah
• MR # :10190103788
• AGE :2 .2 yrs
• DATE OF PRESENTATION : 16/7/19
• Presented post enucleation of the left eye (Multan) and rt eye
group D
• H/O CANCER IN FAMILY : No
• DIAGNOSIS:Bilateral retinoblastoma ,non metastatic
• Right eye: Group D
• Left eye :Enucleated
 Treatment Status of Each Eye
Rt Eye-Group D
– Started with chemo EORB from
19/7/19
– EUA 28/8/19:4 active lesion s
– 1:whitish grey globular shaped 3-
4 D elevated large lesion 11oclk
– 2 raised lesion 2DD at 9 oclk
temporal to fovea
– 3 elevated lesion at 8 o clk 1DD
– 4 Slightly raised ½ DD 5-6
OCLK,vitreous clouds at 11-12 o
clk but moderatelt decreased in
size
Left Eye –Enucleated
Started with EORB chemo from
19/7/19,and after 2 cycles
radiation started to the residual
disease in the left orbut
– On XRT at Zmu
– Blood c/s positive so had lot
of breaks in XRT due to Fever
and issues
Previous EUA R-Group D
Previous EUA R-Group D
Previous EUA R-Group D
LATEST JANUARY 2020 EUA
LATEST JANUARY 2020
LATEST JANUARY 2020
EUA Right Eye Group D
Left Enucleated Group E
 CASE #3
• Mr number :10190023190
• Name :Aliza
• AGE : 1yr
• Presenting complain : Leucocoria – since 6 months
• DATE OF PRESENTATION : H/O CANCER IN FAMILY :
No
• DIAGNOSIS: Bilateral retinoblastoma
• Right eye: Group D
• Left eye : Group C
 Treatment Status of Each Eye
Rt Eye-Group D
– Started with focal therapy at LRBT later on
shifted to Patel
– Completed with 6 cycles of CEV on 19/7/19
– On local therapy at Patel
– EUA 18/9/19:2 aggressive tumor masses
,mass temporally to OD overlaying macula
with calcifications &surrounded by fluid
inferotemporally ,mass inferonasally to disc
dome shaped spehrical ,alonwith inferior
calcified lesion at 7 o clk .Lasered
Left Eye –Group C
Started with focal therapy at LRBT later on
shifted to Patel
Completed with 6 cycles of CEV on
19/7/19
On local therapy at Patel
EUA 18/9/19 :2 Active tumor masses
temporally to OD ,superotemporally to
OD ,Flat looking lesion near to fovea
,inferotemporally to OD ,Calcified
tumor mass surrounded by grey cuff of
fluid .Lasered
LATEST EUGA 22-01-2020
 Plan
• Discuss response and further plan
• To continue local treatment For both eyes ?
 CASE # 4

• NAME :Abdul Wasay

• MR # :10190005548

• DATE OF PRESENTATION : 15/1/19

• AGE AT PRESENTATION : 20 months
• SYMPTOMS AT PRESENTATION :Leukocoria in left eye 2.5 months back

• H/O CANCER IN FAMILY :No

• DIAGNOSIS:Bilateral retinoblastoma non metastatic
• Right eye: Group B
• Left eye :Group D
 Treatment Status of Each Eye
Rt Eye- Group B/D
– Completed with 6 cycles of chemo 17/5/19
– On local therapy at LRBT
– Progression ..group D shifted to patel for local
therapy and started with second line
chemotherapy
– EUA 24/6/19:Lesion#1 1-1.5DD pearly white
flat lesion at periphery 4-5oclk
– Lesion #2 4-5 DD raised pearly white solid
lesion near to dsic
– Lesion #3 huge solid mass involving macula
&disc margin 3-4 DD
– Started with second line chemotherapy
2/8/19
– EUA 21/8/19:All 3 lesions reduced in
size,lasered
– Completed with 5 cycles of chemo on
15/11/19
– EUA 13/11 :Better
Left Eye –Group D
– Completed with 6 cycles of chemo
17/5/19
– On local therapy at LRBT
– EUA 24/6/19:Large active tumor with
calcification involving disc and macula
exudatice RD ,Lasered
– Started with second line chemotherapy
2/8/19
– EUA 21/8/19:Lesion look reduced in size
,lasered
– EUA 16/10: RT BOTH LESIONS
REGRESSED. LASER DONE 568 SHOTS, LT
EXUDATIVE RD LASER NOTPOSSIBLE
– EUA 13/11 : Better
– Completed with 5 cycles of chemo on
15/11/19
Latest Eua 29-01-2020
 Plan
• Further Management?
 CASE # 5

• NAME :Arman
• MR # :10190002344
• AGE :2 months
• DATE OF PRESENTATION : 11/1/19
• SYMPTOMS AT PRESENTATION :Leucocoria rt eye and swelling 15
days
• H/O CANCER IN FAMILY : No
• DIAGNOSIS:Bilateral retinoblastoma ,non metastatic
• Right eye: Group E
• Left eye : B/C
 Treatment Status of Each Eye
Rt Eye-Group E
– Encucleated after 2 cycles of
chemo on 27/2/19
– L/R h/p 27/2/19
– Completed with 6 cycles of
chemo on 14/6/19
Left Eye –Group B/C
Completed with 6 cycles of chemo on 14/6/19
EUA 4/7/19:Lesions 1,2,3,4 inactive
EUA : Lesion 1,2,3,4,5 inactive and scared
,lesion#6 active ,lasered .938 shots given
EUA 9/10 : ATROPEID RETINA AT 9 O CLK WITH
ADJACENT EXUDATIVE RD ,ALL OTHER
LESIONS INACTIVE ,LASERED ON LEISON #6
,HEMORRHAGE WITH EXUDATIVE RD
Started with second line chemo as inadequate
response on local therapy alone
Completed with 2 cycles of EORB on 30/11/19
Latest EUA 08-01-2020
 Plan
• To continue chemo and local therapy for the
left eye
 CASE # 6
• Mr number :10190145827
• NAME : Mohammad Zain
• AGE : 14 months
• Presenting complain : Leucocoria – since 6 months
• DATE OF PRESENTATION : 20/9/19
• Referred from Larkana
• H/O CANCER IN FAMILY : No
• DIAGNOSIS: Bilateral retinoblastoma
• Right eye: Group C
• Left eye : D/Advanced D
 Treatment Status of Each Eye
Rt Eye-Group C
– EUA 1/10:Large tumor mass
elevated ,with nasty looking
feeder vessels ,2 fine
porjections seeds?
– Started with chemo
Completed with 2 cycles of
chemo on 1/11/19
– Eua after 2 cycles :Rt looked
better
– Given third cycle of chemo on
23/11
Left Eye –Group D
– EUA 1/10:Sub retinal
clouds /seeds
Started with chemo ,Completed
with 2 cycles of chemo on
1/11/19
Plan to enucleate after 4 cycles
of chemo
Given third cycle of chemo on
23/11
Right Group C , Left Group D
 PLAN
• Plan to enucleate left eye after 4 cycles of chemo ?
• Complete 6 cycles of chemo and to continue local
therapy for the rt eye
• Agree ?
 Plan
• To complete EORB cycles after XRT
• Response in rt eye
International Retinoblastoma Staging System