Question

A one year old child having leucocoria was found to have a unilateral, large retinoblastoma filling half the globe. Current therapy would involve:

• A. Enucleation
• B. Chemotherapy followed by local therapy
• C. Direct laser ablation using photodynamic cryotherapy
• D. Scleral radiotherapy followed by chemotherapy

Hint:

A large unilateral tumor filling half the globe has no vision worth saving, so the eye is removed.

Answer 1

The Correct Option is A

Step 1: Read the clinical picture.
A one year old child has leucocoria (a white reflex in the pupil instead of the normal red reflex) from a one sided retinoblastoma that already fills half of the eyeball. This is an advanced, large tumor confined to one eye.

Step 2: Recall how retinoblastoma is grouped for treatment.
Retinoblastoma is staged with the International Classification of Retinoblastoma into Groups A to E, based on tumor size, spread within the eye, and how close it is to the retina's center. A tumor filling half the globe falls into an advanced group, where there is little to no chance of saving useful vision and a real risk that the tumor could grow outside the eye if left alone.

Step 3: Match the group to the standard treatment.
Small or medium tumors are treated first with chemotherapy plus local treatment such as laser or cryotherapy, since there is a real chance of saving the eye and some vision. When a tumor already fills half the globe with no visual potential and a threat of spread beyond the eye, removing the eye (enucleation) is the standard and safest step.

Step 4: Rule out the other options.
Chemotherapy with local therapy is meant for smaller tumors that still have a chance of saving the globe and some vision, not one that already fills half the eye. Laser ablation alone cannot destroy a tumor this large and would leave live tumor tissue behind. Scleral (plaque) radiotherapy followed by chemotherapy is kept for smaller, localized tumors, not one this advanced.

Step 5: Final Answer.
For a large, one sided retinoblastoma filling half the globe with no vision to save, enucleation is the correct treatment. \[ \boxed{\text{Enucleation}} \]