Strabismus as a Presenting Sign in Retinoblastoma

Vayani

et al. 2023

Preprint

Purpose To retrospectively analyse globe salvage rates in group D retinoblastoma (RB) with currently available treatment options in Pakistan over a period of nine years. Methods A retrospective, cross-sectional analysis including all patients who presented with Group D RB according to the International Classification of Retinoblastoma (ICRB), from April 2013 to December 2022 at Patel Hospital, Karachi, Pakistan. Indirect ophthalmoscopy done under anaesthesia was used to visualise and evaluate tumour characteristics and clinical response to the treatment offered. Globe salvage was attempted with systemic chemotherapy, local consolidative therapy along with intravitreal melphalan. Survival analysis was performed using Kaplan-Meier curves on SPSS version 26. Results The mean age at diagnosis was 17.2 months.14 (93%) patients had bilateral disease and one (7%) had unilateral disease. Globe salvage was achieved in 11 out of 15 eyes (73.33%) in a mean follow up time of 57.5 weeks (range 7–263 weeks). All eyes received laser therapy, 5 required additional cryotherapy and 1 eye was given adjuvant intravitreal melphalan. 4 eyes underwent secondary enucleation. All eyes amongst this group received systemic chemotherapy, laser, cryotherapy and 3 eyes received intravitreal melphalan (4 cycles). Kaplan-Meier survival analysis showed an overall globe salvage rate of 93%, 76%, and 65% at 1, 2 and 3 years, respectively. No metastasis or deaths were reported. Conclusion Intravenous chemotherapy (IVC) coupled with local therapy remains an effective mode of treatment in select patients with Group D RB despite advancements in treatment modalities like intra-arterial chemotherapy. This is especially promising for developing countries with limited resources and socioeconomic barriers.

Section: Discussionmentioning

confidence: 67%

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

Vayani

et al. 2023

Preprint

“…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].…”

Section: Action #2 Directly Address Common Misconceptions and Myths A...mentioning

confidence: 99%

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

Sherief,

Tesfaye,

Eshetu

et al. 2023

PLoS ONE

Background The majority of childhood blindness causes in low-income countries are treatable or avoidable. Parents or guardians are responsible for making decisions regarding a child’s eye care. Understanding parents’ awareness and perception of eye problems in crucial in helping to know parents’ eye care-seeking behavior. Objective To determine parental knowledge, attitudes and practice regarding child eye health. Methods Seven focus groups were carried out in Northwest Ethiopia on knowledge, attitude and practice of parents towards child eye health. Their responses were tape-recorded and later transcribed. A thematic phenomenological approach was used for the analysis. Result Seventy-one parents participated in the focus groups. Participants were aware of common eye problems like trachoma, trauma, and glaucoma. However, they were unaware of the causes and etiologies of childhood blindness. Participants perceived that eye problems could be treated with hygiene and food, and often held misconceptions about the cause of strabismus and utilization of wearing spectacles. Conclusion The study revealed that parents are often unaware of the causes and etiologies of common childhood eye diseases, which has downstream effects on health-seeking behavior. Health promotion efforts, potentially through mass and social media, could be helpful to raise awareness, coupled with training of health professionals at primary and secondary health facility levels.

Retinoblastoma patients treated in Sri Lanka from 2014 to 2020: epidemiology, clinical status and correlates of lag time in seeking tertiary care services

Kugalingam,

de Silva,

Abeysekera

et al. 2024

BMC Ophthalmol

Background Retinoblastoma (RB) is a tumour of children < 5 years with a incidence of 1 in 20,000. Around 20 RB cases are diagnosed yearly in Sri Lanka, a lower middle-income country with high literacy levels and healthcare free at point of delivery. Incidence, local and systemic severity and mortality related to RB are reportedly high in low- and middle- income countries in comparison to higher income countries. Aims of this study were to describe demographic, socioeconomic, and clinical characteristics of Sri Lankan RB patients attending the designated RB unit at the Lady Ridgeway Hospital (LRH), Colombo between January 2014 to December 2020, and determine correlates of lag time (LT) for first tertiary care visit after detecting the first symptom/sign. Methods Two descriptive cross-sectional studies (DCSS) were conducted, one on 171 RB patients with demographic and clinical data collected between 2017 and 2020. In 2021, the second DCSS took place where socioeconomic and further demographic data were collected using telephone interviews, recruiting a subgroup of 90 (53%), consenting and contactable RB patient/ parent pairs. Bivariate and multivariable analyses were applied to determine correlates of LT of > 4 weeks for first tertiary care visit. Results were expressed as odds ratios and 95% confidence intervals. Results LRH survey (N = 171): Median age at diagnosis was 15 months (range 1–94 months; IQR: 8–27); 89 (52%) were females. Groups D and E tumours were 25.7% (n = 44) and 62.6% (n = 107) respectively with 121 (71%) enucleations. The number of deaths were 2 (1.2%). Telephone survey (N = 90): Proportion with LT of > 4 weeks for first tertiary care visit was 58% (n = 52). None of the putative risk factors (ethnicity, parental educational level, socioeconomic status, distance from residence to tertiary care unit and receiving financial assistance) were associated with LT in both analyses. Conclusion Despite a high proportion with groups D and E tumours and enucleations, mortality rate was low, most likely due to availability of designated tertiary care. No correlates for LT of > 4 weeks for tertiary care presentation were identified. Early RB detection needs rigorous implementation of screening strategies and increased awareness among primary care health workers and parents.