Shields C L, Shields J A, Shah P
Ocular Oncology Service, Wills Eye Hospital, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107.
Ophthalmology. 1991 Mar;98(3):395-9. doi: 10.1016/s0161-6420(91)32283-8.
A review of 400 consecutive patients with retinoblastoma who presented to the Ocular Oncology Service at Wills Eye Hospital showed that 34 (8.5%) patients were older than 5 years of age at the time of initial diagnosis. The tumor was active in 26 (76%) cases and inactive (retinoma) in 8 (24%). An evaluation of the 26 patients with active retinoblastoma showed several unique features. At the time of diagnosis, their median age was 6 years and the oldest was 18 years. In 20 (77%) cases, the patient volunteered symptoms that prompted the eye examination; the presenting symptoms included leukocoria (9 cases), decreased vision (9 cases), strabismus (4 cases), pain (1 case), floaters (1 case), and no symptoms (2 cases). All of the 26 patients (100%) had unilateral sporadic retinoblastoma. Misdiagnosis before referral was common in these older children with active retinoblastoma. Five patients (19%) had prior vitrectomy for presumed vitreous hemorrhage or endophthalmitis while the retinoblastoma was unsuspected clinically, one patient (4%) had cryotherapy for presumed Coats disease, and one (4%) was observed for 7 months for presumed vitreous hemorrhage. The clinician should seriously consider the possibility of retinoblastoma in children who present with signs of unexplained vitreous hemorrhage or endophthalmitis, even if they are older than 5 years of age.
对连续400例就诊于威尔斯眼科医院眼肿瘤服务中心的视网膜母细胞瘤患者进行的回顾显示，34例（8.5%）患者在初次诊断时年龄超过5岁。肿瘤活跃的有26例（76%），不活跃（视网膜细胞瘤）的有8例（24%）。对26例活跃性视网膜母细胞瘤患者的评估显示出一些独特特征。诊断时，他们的中位年龄为6岁，最大年龄为18岁。20例（77%）患者主动诉说了促使眼部检查的症状；出现的症状包括白瞳症（9例）、视力下降（9例）、斜视（4例）、疼痛（1例）、飞蚊症（1例）以及无症状（2例）。26例患者（100%）均为单侧散发性视网膜母细胞瘤。在这些年龄较大的活跃性视网膜母细胞瘤患儿中，转诊前误诊很常见。5例患者（19%）曾因疑似玻璃体积血或眼内炎接受过玻璃体切除术，而当时临床上未怀疑有视网膜母细胞瘤，1例患者（4%）因疑似科茨病接受过冷冻治疗，1例患者（4%）因疑似玻璃体积血被观察了7个月。临床医生应认真考虑那些出现不明原因玻璃体积血或眼内炎迹象的儿童患视网膜母细胞瘤的可能性，即使他们年龄超过5岁。
