Question

A one year old child having leucocoria was found to have a unilateral, large retinoblastoma filling half the globe. Current therapy would involve:

• A. Enucleation
• B. Chemotherapy followed by local therapy
• C. Direct laser ablation using photodynamic cryotherapy
• D. Scleral radiotherapy followed by chemotherapy

Hint:

A large unilateral tumor filling half the globe has no vision worth saving, so the eye is removed.

Answer 1

The Correct Option is A

This question tests how the size and spread of a retinoblastoma inside the eye decide its treatment.

1. Enucleation: When a one sided tumor already fills half the globe, the eye has no useful vision left and carries a risk of the tumor spreading outside the eye. Removing the eye is the safest and standard step in this setting.
2. Chemotherapy followed by local therapy: This eye sparing approach works for smaller tumors where enough healthy retina remains to keep some vision, which does not apply here.
3. Direct laser ablation using photodynamic cryotherapy: Laser and cryotherapy can only clear small, thin tumors; a mass filling half the globe is far too large and thick for these local methods.
4. Scleral radiotherapy followed by chemotherapy: Plaque radiotherapy is kept for smaller, localized tumors that failed other eye sparing treatments, not for a tumor this advanced.

Since the tumor is one sided, large, and already fills half the globe, there is no vision worth preserving, so the eye is removed to protect the child and stop any spread.

Let's summarize:

• Small retinoblastomas get eye sparing chemotherapy plus local laser or cryotherapy.
• Large, advanced, one sided tumors filling much of the globe get enucleation.

So the correct treatment here is enucleation.