The management of unilateral retinoblastoma without primary enucleation.

Sixty-six patients were treated "conservatively" for unilateral retinoblastoma. Forty-eight of 57 (84%) were treated primarily with unilateral radiation, one patient was treated with a cobalt plaque, and eight patients were treated with either cryopexy or xenon arc photocoagulation. With a median follow-up of 73 months, there have been no deaths. Five of 39 eyes that were in groups I to III have been salvaged. Virtually all eyes in groups IV and V (12 of 14) came to enucleation. The age at diagnosis for patients with a positive family history was early (2.5 months), and the patients had a greater number of individual tumors in one eye (2.4), compared with those without a positive family history (27 months, 1.2 tumors per eye). When unilateral retinoblastoma is detected at an early age, the most common sign is strabismus, not leukokoria.