Changing concepts in the management of retinoblastoma.

For many years the most common treatment for retinoblastoma has been enucleation, generally performed on the affected eye in children with unilateral sporadic disease and on the more severely affected eye in children with bilateral disease. With refinements in conservative treatment methods, however, the affected eye now often may be salvaged and useful vision retained. Emphasizing this trend, we present our current approaches to managing retinoblastoma based on our experience with 324 patients, outlining our indications and pointing out a number of misconceptions about the role of enucleation, photocoagulation, cryotherapy, and radiotherapy in treating this condition. We also sketch some recent findings regarding the genetics of retinoblastoma and consider ways in which such research may lead to improved management of the disease.