International Classification of Retinoblastoma (IIRC) Group E tumors are characterized by which features that mandate enucleation as the primary treatment?

• A Tumor ≤3 mm from fovea or optic disc, no vitreous seeding
• B Extensive tumor occupying >2/3 of globe; neovascular glaucoma, opaque media, tumor in anterior chamber ✓
• C Multiple tumors up to 3 cm in size with subretinal seeding <3 mm from base
• D Diffuse infiltrating retinoblastoma without discrete tumor mass

Explanation

IIRC Group E eyes represent the most severe disease: tumor occupying >2/3 of the globe, neovascular glaucoma, opaque media obscuring the tumor, tumor in the anterior segment, or phthisis bulbi. These eyes have essentially no useful vision potential and a high risk of metastasis, making enucleation the treatment of choice. Group A (smallest tumors, <3 mm) can be treated with laser alone. Groups B-D have intermediate features and may benefit from intra-arterial chemotherapy or systemic chemotherapy combined with local treatment.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.