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ARTICLE
Year : 1968  |  Volume : 16  |  Issue : 2  |  Page : 79-80

Retinoblastoma- Involvement of second eye after nine years


Nehru Institute of Ophthalmology and Research, Sitapur, India

Date of Web Publication22-Dec-2007

Correspondence Address:
J M Pahwa
Nehru Institute of Ophthalmology and Research, Sitapur
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Pahwa J M, Goswami A P. Retinoblastoma- Involvement of second eye after nine years . Indian J Ophthalmol 1968;16:79-80

How to cite this URL:
Pahwa J M, Goswami A P. Retinoblastoma- Involvement of second eye after nine years . Indian J Ophthalmol [serial online] 1968 [cited 2019 Dec 13];16:79-80. Available from: http://www.ijo.in/text.asp?1968/16/2/79/37499

Retinoblastoma is one of the commonest tumours in children. It occurs most commonly in early years. Two­-thirds of the cases occur before the end of the third year and more than a third occur in the first year of life. The tumour is bilateral in nearly 20 to 30 per cent cases. The growth in the second eye is an independent focus. Usually the neoplasm is no­ticed in the second eye some months after the first, although its appearance may be delayed by 2-3 years. MAGHY, as quoted by DUKE­ELDER (1945), reported a case where the second eye was involved after 11 years.

The growth in the second eye is probably congenital though it ap­pears after several months. It would seem therefore that only the deve­loping retinal cells are inclined to neoplastic activity for when they reach the adult stage and become highly differentiated, they become so specialised that premature reproduc­tive potentiality is lost. The present case is being reported because the second eye which had 3 foci was in­volved after nearly nine years.


  Case report Top


S. R. Dalal, 9˝ years Hindu male boy referred to us for treatment of retinoblastoma in his only left eye, from Hyderabad. He was examined on 7.7.1967 and the diagnosis of reti­noblastoma was confirmed.

The boy the eldest child and was delivered normally having 6 lb. of weight on, 26.1.58. When the boy was 5˝ months old, his parents noticed amaurotic cat's eye reflex in his right eye. He was diagnosed to be suffering from retinoblastoma, and the eye was enucleated. Histopatho­logical report confirmed the clinical diagnosis. Upto the age of five years the child was regularly examined by his ophthalmologist for any signs of retinoblastoma in his only left eye. The parents were assured that there were no chances of having retinoblas­toma in the other eye.

In November 1966 the patients got the second child. They were anxious to know about the condition of the second child's eyes and thus consult­ed the local eye surgeon in July 1967. The surgeon not only examin­ed the new-born baby but also exam­ined the other eye of our patient and found that there was a growth and thus referred the case to us.

On examination (7.7.67) the vision in the left eye was 6/24. Cornea, anterior chamber and iris were normal, pupil was dilated due to some mydriatic. On fundus examination there were three greyish raised areas in the upper and lower nasal and upper temporal quadrants [Figure - 1]. The upper and temporal focus was raised and of the size of nearly two disc diameters, while the other two on the nasal side were less than one disc diameter in size and not much raised.

On July 8th and 19th all the three lesions were photocoagulated care­fully as advised by Professor Meyer Schwickerath. The patient was dis­charged on July 21, 1967 with the advice to consult after 3 weeks.

The child came to us again in August 1967. The smaller growth in the lower nasal part was already burnt and flattened but the two up­per growths were re-photocoagulated on August 21, 1967. He was advised to come after three weeks again.

On September 19, 1967 the boy was re-examined and found that only the upper temporal lesion was active. There were calcareous whitish spots on this lesion [Figure - 1]. This was again photo-coagulated on Septem­ber 19, 1967, and was again called after a month. [Figure - 2]

On November 21, 1967 the photo­coagulation was repeated in this up­per temporal lesion. Thus the lesion in all was photo-coagulated seven times. During all this period the patient was advised to take ˝ tablet of Endoxon three times a day while a watch was kept on the total and differential W.B.C. count for any leukopaenia.


  Discussion Top


MAYHY as quoted by DUKE EL­DER in 1919 reported a case where one eye was removed at the age of two years while the vision of the other eye began to fail at the age of thirteen years and the eye was excis­ed at the age of 20 years. In our case the retinoblastoma appeared in the other eye after nine years and was successfully treated and cured by 7 photo-coagulation applications and Endoxon therapy.[1]

 
  References Top

1.
DUKE ELDER, S. (1945): Textbook of Ophthalmology, Vol. III, p. 2813, Hen­ry Kimpton, London.  Back to cited text no. 1
    


    Figures

  [Figure - 1], [Figure - 2]



 

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