title: OPTIC NERVE INFILTRATION BY RETINOBLASTOMA: Predictive Clinical Features and Outcome.
abstract: OBJECTIVE
  To identify the clinical features predictive of any optic nerve infiltration and postlaminar optic nerve infiltration by retinoblastoma on histopathology and to report the outcome (metastasis and death) in these patients.
  
  
  METHODS
  Retrospective study.
  
  
  RESULTS
  Of the 403 patients who underwent primary enucleation for retinoblastoma, 196 patients had optic nerve tumor infiltration (Group 1) and 207 patients had no evidence of optic nerve tumor infiltration (Group 2). Group 1 included patients with prelaminar (n = 47; 24%), laminar (n = 74; 38%), and postlaminar tumor infiltration with or without involving optic nerve transection (n = 74; 38%). Comparing Group 1 and Group 2, the patients in Group 1 had prolonged duration of symptoms (>6 months) (16% vs. 8%; P = 0.02) and were associated with no vision at presentation (23% vs. 10%; P = 0.01), higher rates of secondary glaucoma (42% vs. 12%; P < 0.0001), iris neovascularization (39% vs. 23%; P < 0.001), and larger tumors (mean tumor thickness, 12.8 mm vs. 12 mm; P = 0.0001). There was a higher prevalence of metastasis in Group 1 than in Group 2 (4% vs. 0%; P = 0.006). On multivariate analysis, clinical features predictive of any optic nerve tumor infiltration secondary glaucoma (hazard ratio = 5.38; P < 0.001) and those predictive of postlaminar optic nerve tumor infiltration included iris neovascularization (hazard ratio = 2.66; P = 0.001) and secondary glaucoma (hazard ratio = 3.13; P < 0.001).
  
  
  CONCLUSIONS
  In this study, clinical features predictive of any optic nerve tumor infiltration included secondary glaucoma and those predictive of postlaminar optic nerve tumor infiltration included iris neovascularization and secondary glaucoma. Despite adjuvant treatment in those with postlaminar optic nerve tumor infiltration, metastasis occurred in 8% of patients.
authors.affiliation: *Operation Eyesight Universal Institute for Eye Cancer; †Ophthalmic Pathology Service; and ‡Center for Clinical Epidemiology and Biostatistics, LV Prasad Eye Institute, Hyderabad, India.
authors.forename: Swathi
authors.initials: S
authors.lastname: Kaliki
authors.forename: Prerana
authors.initials: P
authors.lastname: Tahiliani
authors.forename: Dilip K
authors.initials: DK
authors.lastname: Mishra
authors.forename: Visweswaran
authors.initials: V
authors.lastname: Srinivasan
authors.forename: Mohammed Hasnat
authors.initials: MH
authors.lastname: Ali
authors.forename: Vijay Anand P
authors.initials: VA
authors.lastname: Reddy
mesh_terms: D002675:Child, Preschool; D015353:Eye Enucleation; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009361:Neoplasm Invasiveness; D019574:Optic Nerve Neoplasms / Q000401:mortality / Q000473:pathology*; D019572:Retinal Neoplasms / Q000401:mortality / Q000473:pathology*; D012175:Retinoblastoma / Q000401:mortality / Q000473:pathology*; D012189:Retrospective Studies; D015996:Survival Rate