Question

A 5-year-old boy presented with leukocoria in the right eyeball, which is diagnosed as diffuse retinoblastoma involving the entire globe, while the other eye had 2 to 3 small lesions in the periphery. What will be the ideal management for this patient?

• A. Enucleation of both eyes
• B. Enucleation of the right eye and conservative management for the other eye
• C. Enucleation of the right eye and focal therapy for the other eye
• D. 6 cycles of chemotherapy

Hint:

Stage each eye separately: remove the globe-filling eye, save the lightly involved eye with focal treatment.

Answer 1

The Correct Option is C

Step 1: Classify each eye separately. This is bilateral retinoblastoma, so each eye is staged on its own. The right eye has diffuse tumour filling the whole globe (advanced, Group E), while the left eye has only 2 to 3 small peripheral lesions (early, salvageable).
Step 2: Decide for the advanced eye. An eye with diffuse tumour involving the entire globe has no useful vision and cannot be salvaged; enucleation of that (right) eye removes the bulk of tumour and gives the best chance of controlling disease.
Step 3: Decide for the better eye. The fellow eye has only small peripheral tumours and potentially useful vision, so it should be preserved. Small, well-localized lesions are ideally treated with focal (local) therapy such as laser photocoagulation, cryotherapy or transpupillary thermotherapy, usually combined with chemoreduction as needed.
Step 4: Reject the wrong choices. Bilateral enucleation needlessly blinds the child when the second eye is salvageable. Conservative management of the diffusely involved right eye risks tumour spread and death. Chemotherapy alone will not eradicate a globe-filling tumour and is not a stand-alone cure.
Conclusion: Enucleate the right (diffusely involved) eye and use focal therapy to save the lightly involved left eye.