Retinoblastoma in a Referral Center in Nigeria: 7- year Review of Changing Pattern of Presentation and Lag Time

Abstract

Background: Improvement in survival from retinoblastoma (RB) improved to about 98% in developed countries because of early presentation and prompt intervention at designated RB care center, whereas in low-resourced countries, late presentations and poor survival are not unusual. This study reviews the changing pattern of presentations over a 7-year period when various efforts were deployed to improve early presentation and intervention in a low-resourced setting. Materials and methods: Data were extracted from RB clerk sheets that were used for documentation of clinical records of patients with RB managed at a single tertiary referral center for RB in Nigeria between 2013 and 2019. The data were analyzed for changing trend of clinical presentation and lag time. Ethical approval was obtained from the institution. Results: Two hundred and twenty-two eyes of 148 children were reviewed. There were 79 males and 69 (46.6%) females, and male to female ratio was 1.14:1. There were 74 (50%) unilateral, 72 (48.6%) bilateral, and 2 (1.4%) trilateral cases. Discussion: Overall, 66 (44.6%) and 82 (55.4%), patients had shown symptoms by 6 months and 1 year, respectively, whereas only 39 (25.7%) had presented by 1 year. Early disease stage presenting as leukocoria increased from 22.2% to 85.7%, whereas late presentation as proptosis declined from 55.5% to 10.7% between 2013 and 2019. Some cases were identified during vision screening performed by community health workers during routine immunization at primary healthcare clinics. At presentation, 188 (84.7%) RB eyes were intraocular, 32 (14.4%) orbital, and 2 (0.9%) had systemic spread. The median of the lag-time (delay) between when symptom was noticed to presentation reduced gradually each year by 1 month, from a median of 9 months in 2013 to 4 months in 2018. Conclusions: In Nigeria, early presentation as leukocoria increased, whereas late presentation as proptosis and lag time in RB reduced significantly from year 2013 to 2019 which was supported by deliberate efforts to educate the public and institute training across all levels of health care. In low-resourced country like ours, achieving early presentation of RB cases would increase the survival of affected children.