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The authors present a retrospective cohort study. Data was extracted from the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) database, based in the US and founded in 1973. Cases of retinoblastoma were extracted using the inclusion criteria of first primary tumour and choroidal invasion data available. The authors specify the studies definition and levels of choroidal invasion (no, focal or massive invasion) with further stratification by optic nerve invasion (optic nerve invasion up to but not through, or through the lamina cribrosa). The aim of the study was to assess how choroidal invasion impacted on survival rates. A total of 393 cases of retinoblastoma met the inclusion criteria from a 12-year period. All included cases were managed with enucleation. At the time point of enucleation the level of choroidal invasion was 68% none, 23% focal and 9% massive. The follow-up period was for a mean of 72 (+/- 47) months. Additional management includes chemotherapy for 38% and radiation for 3%. This additional management was statistically significantly associated with higher levels of choroidal invasion. A total of six deaths including four cancer-related deaths occurred during the follow-up period. All cause mortality was significantly higher in the group with massive choroidal invasion. All four cancer related deaths had massive choroidal invasion with concomitant post laminar optic nerve invasion. The authors suggest that it is the level of optic nerve involvement that could contribute to increased mortality. Further research is required to assess the level of optic nerve involvement, specifically beyond the lamina cribrosa as an independent risk factor for mortality.

Association of choroidal invasion with retinoblastoma survival rates.
Loya A, Ayaz T, Gombos DS, Weng CY.
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Lauren R Hepworth

University of Liverpool; Honorary Stroke Specialist Clinical Orthoptist, Northern Care Alliance NHS Foundation Trust; St Helen’s and Knowsley NHS Foundation Trust, UK.

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