Review Article
Trends in the Management of Retinoblastoma: Evaluation of 1,196 Consecutive Eyes During 1974 to 2001

John A. Epstein, MD; Carol L. Shields, MD and Jerry A. Shields, MD

EXCERPT

Retinoblastoma is the most common malignant intraocular tumor in children,¹ occurring in approximately 1 of 23,000 live births.² For many years, the conventional treatment of retinoblastoma was primary enucleation.³ More recently, several authors have reported a trend toward the decreasing frequency of enucleation in the management of retinoblastoma.^2-6 This has been largely attributed to earlier diagnosis and previous success with conservative management^7,8 such as external beam radiotherapy,^9,10 photocoagulation,¹¹ cryotherapy,¹² and plaque irradiation.¹³ Recent advancements in the use of chemoreduction combined with local therapy^14-16 have greatly expanded clinical options and the effect on the overall enucleation rate for retinoblastoma has not yet been explored. In this article, we examine our experience with the management of retinoblastoma during 12 years (1989 to 2001) and compare treatment strategies, especially the need for enucleation, of this period with those of the period 1974 to 1988.

AUTHORS

The authors are from the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.

Originally submitted January 20, 2003.

Accepted for publication March 27, 2003.

Address reprint requests to Carol L. Shields, MD, Ocular Oncology Service, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA 19107.

Presented in part at the Annual Meeting of the Association for Research in Vision and Ophthalmology; May 4-10, 2002; Ft. Lauderdale, FL. Presented in its entirety at the Annual Meeting of the American Academy of Optometry; December 12-15, 2002; San Diego, CA.

Supported by the Paul Kayser International Award of Merit in Retina Research, Houston, Texas; the Lions Eye Bank, Philadelphia, Pennsylvania; the Macula Foundation, New York, New York; and the Eye Tumor Research Foundation, Philadelphia, Pennsylvania.

The authors have no industry relationships to disclose.

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