title: Clinicopathologic review of pediatric enucleations during the last 50 years.
abstract: OBJECTIVE
  To evaluate diagnoses leading to enucleations in the pediatric age group over time.
  
  
  METHODS
  All pathology reports of enucleation specimens at the University of California-San Francisco eye pathology laboratory from children (ages 0 to 18 years) from 1960 to 2008 were reviewed. The main outcome measures were the frequency of pediatric enucleation specimens in each diagnostic category as compared with total pathological laboratory volume over time, and the age and gender distribution of histopathological diagnostic categories over time.
  
  
  RESULTS
  Specimens of 746 eyes from 729 pediatric patients were analyzed. Pediatric enucleated eyes constituted 2.7% of all specimens received at the pathology laboratory. The overall frequency of pediatric enucleation specimens did not change over time. Retinoblastoma specimens increased by a factor of 2.9 over time (p < 0.0001). The increase in retinoblastoma was offset by a decrease in nonretinoblastoma enucleations, which decreased by a factor of 3.8 between the 1960s and 2000s (p < 0.0001), driven by a decrease in enucleations caused by trauma (p < 0.0001). Beginning in the 1980s, pediatric enucleations caused by nonrhegmatogenous retinal detachment, nematode and non-nematode endophthalmitis, and congenital glaucoma decreased significantly. Retinoblastoma was the most common diagnosis overall (45%), in girls (60%), and in ages <5 years (78%). Trauma was the second most common diagnosis (32%) and the most common in boys (42%) and in children ages 6-12 (58%) and 13-18 (72%) years.
  
  
  CONCLUSIONS
  A decrease in pediatric nonretinoblastoma enucleations was observed over time, possibly attributable to better diagnostic capabilities, surgical techniques, and public health interventions. The increase in retinoblastoma enucleations over time was likely due to the result of institutional referral bias.
authors.affiliation: Department of Ophthalmology, Pediatric Ophthalmology and Strabismus, University of California-San Francisco, 10 Koret Way, San Francisco, CA 94143, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Huang
authors.forename: J Brooks
authors.initials: JB
authors.lastname: Crawford
authors.forename: Travis
authors.initials: T
authors.lastname: Porco
authors.forename: Tina
authors.initials: T
authors.lastname: Rutar
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005128:Eye Diseases / Q000473:pathology* / Q000601:surgery; D015353:Eye Enucleation / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D014481:United States