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Ophthalmic Images |

Invisible Retinoblastoma Online Only

Jarin Saktanasate, MD1; Sritatath Vongkulsiri, MD2; Chloe T. L. Khoo, BS3
[+] Author Affiliations
1Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
2Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
3Thomas Jefferson University, Philadelphia, Pennsylvania
JAMA Ophthalmol. 2015;133(7):e151123. doi:10.1001/jamaophthalmol.2015.1123.
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A 2-month-old baby boy presented with decreased red reflex and multifocal retinoblastomas in both eyes. After 6 cycles of intravenous chemotherapy and 2 cycles of intra-arterial chemotherapy, in addition to transpupillary thermotherapy, all tumors showed regression. In the right eye, 4 circumscribed regressed retinoblastoma scars were noted. A tiny invisible type 0 regressed retinoblastoma (Figure, A; arrowhead), not seen in color fundus photography or fluorescein angiography, was noted by intraoperative infrared reflectance imaging and spectral-domain optical coherence tomography (OCT; iVue, Optovue Inc). The OCT depicted a circumscribed ovoid hyperreflective mass in the outer nuclear layer (Figure, B). Scattered foci of intralesional hyperreflectivity were seen. This regressed lesion remained stable during 5 months of monitoring with OCT.

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Figure.

A, Color fundus photograph of the right eye shows 4 regressed retinoblastoma scars. The arrowhead indicates an invisible tumor. B, Spectral-domain optical coherence tomography of the invisible tumor (arrowhead in panel A) shows a circumscribed hyperreflective mass in the outer nuclear layer with scattered intralesional hyperreflectivity foci. The inset image is the infrared image of the location where the optical coherence tomographic image was taken.

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