Aims To correlate the clinical and histopathological findings of eyes primarily enucleated for advanced intraocular retinoblastoma.

Methods In a retrospective study, the authors identified patients primarily enucleated for advanced intraocular retinoblastoma. The authors retrieved patient demographics, clinical findings, subsequent treatments and outcomes, and reviewed the histopathology of each eye for invasion of the anterior chamber, iris, ciliary body, choroid, sclera and optic nerve, and extraocular extension. The authors used the Fisher exact, exact Jonkheere–Terpstra, exact Wilcoxon rank sum and Kruskal–Wallis statistical tests (p<0.05) to study associations between clinical and histopathological findings.

Results The authors identified 67 eyes of 67 patients (33 males) primarily enucleated for retinoblastoma between March 1997 and January 2008. Corneal diameter, intraocular pressure and Reese–Ellsworth Classification had no significant association with invasive disease. The International Classification, however, was associated with optic nerve (p=0.026), choroid (p<0.001), ciliary body (p=0.002), iris (p=0.002), anterior chamber (p=0.025) and scleral (p<0.001) invasion. Eyes classified as International Classification Group E were more likely to have invasion of these sites and have more severe optic-nerve invasion.

Conclusions Corneal diameter, intraocular pressure and Reese–Ellsworth Classification do not correlate with histopathological evidence of invasive retinoblastoma. Eyes classified as International Classification Group E are more likely to have elevated intraocular pressure, invasion of the anterior chamber, uveal tract, optic nerve and sclera. The findings warrant primary enucleation with meticulous histopathological examination of such eyes prior to any adjuvant therapy.