Question

A 5-year-old boy presented with leukocoria in the right eyeball, which is diagnosed as diffuse retinoblastoma involving the entire globe, while the other eye had 2 to 3 small lesions in the periphery. What will be the ideal management for this patient?

• A. Enucleation of both eyes
• B. Enucleation of the right eye and conservative management for the other eye
• C. Enucleation of the right eye and focal therapy for the other eye
• D. 6 cycles of chemotherapy

Hint:

Stage each eye separately: remove the globe-filling eye, save the lightly involved eye with focal treatment.

Answer 1

The Correct Option is C

Handle the two eyes as two different problems, because bilateral retinoblastoma is staged eye by eye and the goal is to save life first, then vision.

The right eye is described as diffuse tumour filling the entire globe. That is an advanced, blind, unsalvageable eye, and the safest, most definitive step is to remove it. Enucleation takes out the large tumour load and reduces the risk of local and systemic spread, so the right eye is enucleated.

The left eye is the opposite situation: just 2 to 3 small lesions sitting in the periphery, with vision worth preserving. Such small, discrete tumours are the textbook target for eye-conserving focal treatments (laser photocoagulation, cryotherapy, thermotherapy), often supported by chemoreduction. So the left eye gets focal therapy, not removal.

The other options fail the life-versus-sight balance: removing both eyes blinds a child whose second eye is salvageable; watching the globe-filling right eye is dangerous; and chemotherapy by itself cannot clear a fully involved globe. The correct combined plan is enucleate the right eye and apply focal therapy to the left.
\[\boxed{\text{Enucleation of the right eye and focal therapy for the other eye}}\]