Strabismus as a Presenting Sign in Retinoblastoma

Abstract

To report the presenting signs of Retinoblastoma (Rb) in a large cohort of patients who underwent orthoptic assessment at presentation. METHODSA retrospective medical chart review of 131 patients with retinoblastoma who presented consecutively to a single institution over a 6-year period. The main outcome measure was the presenting sign(s) of the disease. RESULTSOf 131 Rb patients, 88 presented with unilateral disease and 43 bilateral disease (mean age; 22.7 and 14.8 months respectively). Leukocoria (L) was the presenting sign in 56% of patients, leukocoria and strabismus (LS) in 18%, strabismus (S) in 13%, inflammation (I) in 8%, and 'other' signs in 5%. The fovea was affected by the Rb tumor or its sequelae in 75% of cases. Patients who presented with strabismus were significantly more likely to have foveal involvement than patients who presented with leukocoria alone (P = 0.001). 31% of patients had strabismus as a component of their presentation; 63% had exotropia, 23% had esotropia, and 14% had variable strabismus. The percentage of patients with strabismus rises to 66% if small angle and variable strabismus is also considered. Patients with inflammation had worse ocular survival (P <0.05). CONCLUSIONSThe combination of leukocoria and strabismus as presenting features of Rb has been assessed. Foveal involvement is common in patients who have strabismus and may influence decision-making regarding globe salvage. We have confirmed that exotropia is more common than esotropia in Rb in the largest cohort to have undergone an orthoptic assessment.

Clinical outcomes of Group D Retinoblastoma at a tertiary care hospital in Pakistan

“…The most common presentation in our patients was leukocoria followed by strabismus which are the two most common presenting complaints of RB documented in medical literature [10]. Genetic testing is a scant resource in the developing world, therefore, based on verbal con rmation during history taking, it was found that two patients (13.33%) had a positive family history for RB.…”

Exploring the knowledge, attitudes, and practice towards child eye health: A qualitative analysis of parent experience focus groups

“…A study from Chennai, India indicated that the majority of parents in that setting believed that strabismus was a sign of good fortune and did not seek care for [19]. Sometimes, strabismus can be the first sign of ocular tumor, like retinoblastoma [43]. Poor parental education, misunderstandings, and misinformation have a negative impact on the age of strabismus presentation and management, which differs from country to country [44].…”