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The management of retinoblastoma has undergone a paradigm shift in the recent past. While the focus continues to be on improved survival and long-term safety of treatment modalities, the stress now is on optimisation of vision. A substantial reduction in the frequency of enucleation has occurred in the last few decades—from 96% in 1974 to less than 75% now for unilateral retinoblastoma, and from 68% before 1989 to 44% now for bilateral retinoblastoma.1–4 Similarly, the proportion of cases treated with radiotherapy has sharply decreased from 35% in 1985–1989 to 7% in 2000–2004.5 Concurrently, there has been an increase in the use of alternative eye- and vision-conserving methods of treatment.6–10
Chemoreduction with focal consolidation is now extensively used in the primary management of retinoblastoma.6–10 Standard triple drug chemoreduction (Vincristine+Etoposide+Carboplatin) is most effective for tumours without associated subretinal fluid or vitreous seeding.6–10 Success, defined as eye salvage, is reported in 85% of treated patients when the tumour is less advanced (Reese–Ellsworth groups I …
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