Enucleated pseudoretinoblastoma: A six-year review from a Philippine Center

Objectives@#To evaluate the prevalence, etiologies, demographics, and clinical presentation of enucleated pseudoretinoblastoma. @*Methods@#This retrospective study reviewed ocular pathology records of enucleated globes with clinically diagnosed or suspected retinoblastoma submitted to a public university ocular pathology laboratory from 2013 to 2018. Hematoxylin-eosin-stained sections of pseudoretinoblastoma cases were reevaluated, and additional clinical data were taken from hospital charts.@*Results@#Of the 211 enucleated eyes with clinically diagnosed or suspected retinoblastoma, 202 (95.7%) had histologically confirmed retinoblastoma, while 9 (4.3%) had pseudoretinoblastoma. The most common ocular conditions mimicking retinoblastoma were retinal dysplasia (2 eyes) and persistent fetal vasculature (2 eyes). The pseudoretinoblastoma group consisted of 4 females and 5 males, and enucleated were 6 right eyes and 3 left eyes. The mean age at the time of enucleation was 3.65 years, and the mean symptom duration was 17.36 months. Leukocoria, which was noted in 4 patients, was the most frequent initial symptom. No significant difference between the pseudoretinoblastoma group and the retinoblastoma group were found in terms of sex, laterality of the enucleated eye, age at the time of enucleation, and symptom duration.@*Conclusion@#In this retrospective review, the prevalence of pseudoretinoblastoma in enucleated globes clinically suspected or diagnosed with retinoblastoma was 4.3%. Persistent fetal vasculature and retinal dysplasia were the most common pseudoretinoblastomas. Clinicians should perform a thorough clinical evaluation and judiciously utilize the available diagnostic means to differentiate retinoblastoma from pseudoretinoblastoma.

Time reduction of new patient consultation at the Department of Ophthalmology and Visual Sciences of a Philippine Tertiary Hospital

Objective@#To decrease the total time spent of new patients on a General Clinic consult at the Department of Ophthalmology and Visual Sciences of a Philippine Tertiary Hospital. @*Methods@#A time quality management team was formed. The description of the process of a General Clinic new patient consult was elucidated and was consolidated in a data collection form. Convenience sampling of the population was done. The collection and analysis of the data were done with institution of interventions to address the factors causing the prolonged consultation visit; then, pre-intervention analysis, post-intervention analysis and comparison were done. @*Results@#Thirty-five new patients were tracked prior to and after intervention. Among the identified causes for prolonged new patient consult were delay in temporary chart, front of chart and blue card issuance, insufficient examination tools and resident dedicated to the General Clinic, unnecessary examination and patient not being around when called. Most causes were addressed. A mean decrease of 68±112 minutes or approximately 18% in total time stay was noted. @*Conclusion@#This study showed that the total consultation time of a new patient in General Clinic decreased. This was achieved with the help of most of the personnel involved in the system after identifying factors causing the prolonged consultation visit and instituting interventions to address these identified factors. The improvement in health service delivery was taken as a step by step process. A preliminary step was demonstrated in this paper for future interventions for better service delivery.

Outcome of retinoblastoma patients with high-risk histopathological features in a tertiary hospital

Objectives@#To describe the outcome of patients with bilateral or unilateral retinoblastoma with high-risk histopathological features managed at a tertiary hospital in the Philippines. @*Methods@#This was a descriptive, retrospective review of retinoblastoma cases with high-risk histopathological characteristics seen at a tertiary hospital from January 1999 to July 2012. Out of 239 patients, those with at least one of the following features were included in the study: positive cut optic nerve margin, postlaminar optic nerve involvement (PLONI), intra- or extrascleral involvement, choroidal invasion, and anterior segment involvement. We determined the number of patients who developed orbital recurrence and metastasis, otherwise known as events, within 1 year after enucleation or exenteration and compared the outcomes between those who received and did not receive adjuvant therapy. @*Results@#Of the 82 eyes of 79 patients with high-risk histopathologic features, 25.6% had orbital recurrence and 18.3% developed central nervous system, lymph node, or distant metastasis. None with isolated choroidal involvement (n=24) or combined choroidal and anterior segment involvement (n=4) developed recurrence or metastasis. Patients with isolated anterior segment (n=1) and PLONI with negative margin involvement (n=1) remained event-free with chemotherapy. The following developed orbital recurrences: 2 of 9 patients with combined choroid and scleral involvement, and 1 of 8 patients with PLONI negative margin and choroidal involvement. These patients did not receive immediate postoperative chemotherapy. Two out of 4 patients with isolated PLONI with positive margin of resection developed metastasis despite adjuvant therapy. Of 12 patients with combined choroid, scleral, or anterior segment and PLONI with positive margin involvement, only 3 of the 7 patients who received full chemotherapy remained event-free, while the rest developed orbital recurrence or metastasis (9 of 12). Of 17 patients with extrascleral involvement and varying degrees of intraocular involvement and optic nerve margin involvement, only 3 of the 9 who received full chemotherapy remained event-free, including two who received an intensive chemotherapy course. @*Conclusions@#Isolated choroidal and combined choroid and anterior segment involvement had no recurrences or metastasis either with or without adjuvant therapy. Patients with combined choroid and scleral involvement and those with PLONI, negative margin with choroidal involvement had better outcomes with adjuvant therapy than without. Patients with the following features developed events despite adjuvant therapy: positive optic nerve margin combined with any ocular tissue involvement, and extrascleral involvement combined with any other feature. We recommend giving a timely and complete chemotherapy regimen to prevent recurrence or metastasis in combined choroid and scleral involvement, and PLONI negative margin with choroidal involvement. We suggest intensive chemotherapy for patients with positive margin involvement or extrascleral involvement. Further studies are recommended to establish the need for chemotherapy in isolated PLONI.

A vision to remember

@#On May 1911, the Department of Eye, Ear, Nose, and Throat (EENT) of the Philippine General Hospital (PGH) was established under the able leadership of Dr. Reinhart Remebe. As part of its commitment to pursue excellence and unconditional service, the graduates of what was then the Philippine Medical School (now the University of the Philippines College of Medicine (UPCM)) had to undergo a month of comprehensive training as an orientation to the department.

A review of pseudoretinoblastoma cases at a tertiary hospital

Objective@#To report various intraocular conditions that mimic retinoblastoma.@*Methods@#A review was conducted of eyeballs enucleated for suspected retinoblastoma between 2003 and 2007, and referred for histopathological confirmation. The slides of cases not histopathologically consistent with the diagnosis of retinoblastoma were reexamined. Clinical records and results of neuroimaging studies were reviewed retrospectively@*Results@#Of the 197 eyeballs examined, 182 (92%) proved to be retinoblastoma on histological exam, while 15 (8%) from 13 patients were pseudoretinoblastomas. The age of patients ranged from 4 months to 9 years, with a mean of 35.5 months. The etiologies of the pseudoretinoblastomas were as follows: persistent primary hyperplastic vitreous (PHPV) in 5 eyeballs (33%); retinal dysplasia in 3 (20%); Coats’disease, phthisis bulbi, and vitreous hemorrhage with retinal detachment in 2 (13%) each; and granulomatous endophthalmitis in 1 (8%).@*Conclusion@#The 8% erroneous diagnosis was lower than the published rates of 10 to 20%. The common etiologies of pseudoretinoblastoma were similar to those reported.