Global Retinoblastoma Study Group IMPORTANCE Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale.OBJECTIVES To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. DESIGN, SETTING, AND PARTICIPANTSA total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. MAIN OUTCOMES AND MEASURESAge at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. RESULTSThe cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low-and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI,, and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI,). CONCLUSIONS AND RELEVANCEThis study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs.

BackgroundThe travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe.MethodsA cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries.ResultsCapture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI −12.4 to −5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease.ConclusionsFewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral.

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BaCkground: Post-traumatic endophthalmitis with retained intraocular foreign body is a severe complication of open globe injuries. It is generally associated with poor visual outcome and requires prompt and adapted management. Case report: A 39-year-old male patient presented with open globe injury of the right eye due to a metallic foreign body projection. He was a victim of a neglected work accident 10 days ago when hammering a metallic bar. Visual acuity on admission was LP (+) in the right eye. The Slit-lamp examination revealed perikeratic injection, edematous cornea and severe inflammation of the anterior chamber with hypopyon. Ocular ultrasound showed a heterogeneous vitreous organization compatible with a vitreous abscess. Orbito-cerebral CT scan revealed a retained intraocular metallic foreign body located in the posterior segment, within the vitreous humor. The patient received local and general antibiotherapy associated with intravitreal injections of vancomycin and ceftazidime followed by a vitrectomy to remove the intraocular foreign body. The visual outcome was poor with an evolution towards phtysis bulbi. The aim of this case report is to study the risk factors of post-traumatic endophthalmitis with retained intraocular foreign body and to examine treatment principles and visual outcome of this severe complication.

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Original Research ArticleAim: To study epidemiological, clinical and therapeutic characteristics of eyelid basal cell carcinomas and to emphasize the interest of early diagnosis and appropriate management of this pathology. Methods: We report a retrospective study of 30 cases of eyelid basal cell carcinoma, collected between 2009 and 2019. All our patients underwent a complete ophthalmological examination, a general examination (with search for preauricular or submandibular lymphadenopathy) and a biopsy-excision of the tumor. Orbito-cerebral CT scan was requested in tumors with locoregional extension. Results: The average age was 59 years with sex ratio equal to 1. The notion of smoking was found in 48% of cases and Xeroderma Pigmentosum in 10% of cases. The tumor was located in the lower eyelid in 2/3 of the cases. Surgical treatment involved 28 cases, or 94%. Eyelid reconstruction was required in 24 cases. We noted two cases of recurrence requiring additional resection. Conclusion: Basal cell carcinoma is the most frequent malignant tumor of the eyelids. The treatment is mainly surgical. Radiotherapy is indicated for incomplete excision, neural invasion or recurrence. The prognosis essentially depends on the risk of recurrence.

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