Retinoblastoma: Clinical Picture and Grouping at the Time of First Presentation in Patients Attending Paediatric Oncology Ward at Muhimbili National Hospital

Abstract

Introduction: Retinoblastoma (Rb) is the most common intraocular and life threatening eye cancer that affects mainly children under the age of five years. In developing countries including Tanzania, 50-70% of affected children die because they are diagnosed too late to save their lives. Delay in diagnosis, referral, treatment and follow up increase morbidity and mortality rate. The aim of this study was to identify clinical picture and group the eye according to the International Classification at the time of first presentation in patients attending pediatric oncology ward at Muhimbili National Hospital (MNH).` Methodology: Descriptive cross sectional study was conducted in oncology ward at MNH, Dar es Salaam from April to December 2016.The study involved 72 patients with retinoblastoma. Parents/caretakers of every patient were interviewed in detail. Patients were examined under general anesthesia to measure horizontal corneal diameter, intraocular pressure, anterior segment of the eye and fundoscopy with indentation was performed using indirect ophthalmoscope. International classification of Retinoblastoma (ICRB) was used for grouping the disease. Ultrasonography, neuroimaging and histology to confirm the tumor were also performed. Results: 72 patients were found to have Rb with a median age of 28 months, Interquartile Range (IQR) of (17-42 months). Out of 72 patients, 39(54.2%) were males and 33(45.8%) females. Majority of cases were from Coastal and Lake Zones. Family history of Rb was positive in only one patient who had bilateral Rb. Unilateral Rb was the most predominant type of the disease seen in 54(75.0%) patients. The commonest first clinical presentation noted by the family was Leukocoria reported in 56(77.8%) patients though at MNH about 30(41.7%) patients presented with proptosis. At the time of presentation at MNH, both bilateral and unilateral cases had advanced disease (group E and extraocular extension) where 84 eyes out of 90 eyes were indicated for enucleation. The median lag time was 4 months. Conclusion: Leukocoria is the commonest first sign of retinoblastoma at home. Majority of the patients presented to MNH in advanced stage of the disease though they were taken to local peripheral hospitals early enough. Programs to raise awareness on retinoblastoma to both health workers and the community are important for early case detection, referral, diagnosis and treatment