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Examinations under anaesthesia as a measure of disease burden in unilateral retinoblastoma: the London experience
  1. Ido Didi Fabian1,2,3,
  2. Vishal Shah1,
  3. Noa Kapelushnik3,
  4. Zishan Naeem2,
  5. Zerrin Onadim2,
  6. Elizabeth Price2,
  7. Tanzina Chowdhury2,4,
  8. Catriona Duncan2,4,
  9. David Stansfield5,
  10. Mandeep Sagoo2,6,
  11. Maddy Ashwin Reddy1,2
  1. 1 Moorfields Eye Hospital, London, UK
  2. 2 Retinoblastoma Service, Royal London Hospital, London, UK
  3. 3 Ocular Oncology Service, Goldschleger Eye Institute, Sheba Medical Center,Tel-Aviv University, Tel Aviv, Israel
  4. 4 Paediatric Oncology Department, Great Ormond Street Hospital, London, UK
  5. 5 Anaesthetic Department, Royal London Hospital, London, UK
  6. 6 NIHR Biomedical Research Centre for Ophthalmology at University CollegeLondon, Institute of Ophthalmology and Moorfields Eye Hospital, London, UK
  1. Correspondence to Dr Ido Didi Fabian, Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK; didifabian{at}


Background Early diagnosis strategies and advances in retinoblastoma (Rb) management have resulted in nearly 100% survival. More attention should, therefore, be given to quality of life considerations. We aimed to quantify the number of examinations under anaesthesia (EUAs) in a cohort of patients with Rb, as a measure of disease burden.

Methods A retrospective analysis of patients with unilateral Rb that presented to the London Rb service from 2006 to 2013, were treated and had long-term follow-up. Correlations of clinical variables to number of EUAs were investigated.

Results A total of 107 patients with Rb were included that presented at a mean age of 26.51 ± 22.68 months. The International Intraocular Retinoblastoma Classification (IIRC) was group B in 5 (5%), C in 13 (12%), D in 48 (45%) and E in 41 (38%) of the cases. Primary treatment was intravenous chemotherapy in 36 (34%) and enucleation in 71 (66%) of the cases. Mean number of EUAs was 20.67 ± 6.62, 12.52 ± 6.23 and 11.15 ± 6.91 for combined groups B/C, group D and group E patients (p < 0.001), respectively. On analysis, early age atpresentation and conservative treatments were found to significantly correlate with increased number of EUAs (p < 0.001). Mean follow-up time was 74.42 ± 25.16 months and no metastasis or death were reported.

Conclusion Families should be counselled regarding the number of EUAs associated with the patient's IIRC group, with B/C eyes undergoing twice the number as compared with D/E eyes. For group D cases, where both enucleation and conservative therapy are valid options, treatment choice has a significant impact on the number of EUAs.

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  • Contributors IDF and MAD had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of data analysis. Study concept and design: IDF and MAD. Acquisition, analysis or interpretation of data: all authors. Drafting of the manuscript: IDF and MAD. Critical revision of the manuscript for important intellectual content: all authors. Administrative, technical or material support: all authors. Study supervision: IDF and MAD.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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