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Clinicopathologic review of pediatric enucleations during the last 50 years
Susan Huang1, J Brooks Crawford, Travis Porco
1Department of Ophthalmology, Pediatric Ophthalmology and Strabismus, University of California-San Francisco, 10 Koret Way, San Francisco, CA 94143, USA.
Insights
Pediatric enucleations for non-retinoblastoma diagnoses decreased significantly over time, while retinoblastoma cases increased, possibly due to improved diagnostics and referral patterns. This impacts understanding of pediatric eye conditions.
Area of Science:
- Ophthalmology
- Pediatric Pathology
- Oncology
Background:
- Enucleation is a critical procedure for pediatric eye conditions.
- Understanding trends in enucleation diagnoses is vital for public health and clinical practice.
- Historical data provides insights into changing disease patterns and interventions.
Purpose of the Study:
- To analyze the changing diagnostic landscape of pediatric eye enucleations over a nearly 50-year period.
- To identify trends in specific diagnoses leading to enucleation in children.
- To examine age and gender distributions within diagnostic categories.
Main Methods:
- Retrospective review of 746 pediatric enucleation specimens (ages 0-18) from 1960-2008.
- Analysis of pathology reports from a single, high-volume eye pathology laboratory.
- Comparison of diagnostic frequencies over time relative to total laboratory volume.
Main Results:
- Pediatric enucleations represented 2.7% of all pathology specimens; overall frequency remained stable.
- Retinoblastoma diagnoses increased significantly (2.9x), while non-retinoblastoma diagnoses decreased (3.8x), particularly trauma.
- Retinoblastoma was most common in girls and younger children; trauma predominated in boys and older children.
Conclusions:
- Decreased non-retinoblastoma enucleations suggest improved diagnostics, treatments, and public health measures.
- Increased retinoblastoma enucleations may reflect institutional referral biases.
- Long-term trends highlight shifts in the etiology of pediatric eye diseases requiring enucleation.
Purpose:
To evaluate diagnoses leading to enucleations in the pediatric age group over time.
Methods:
All pathology reports of enucleation specimens at the University of California-San Francisco eye pathology laboratory from children (ages 0 to 18 years) from 1960 to 2008 were reviewed. The main outcome measures were the frequency of pediatric enucleation specimens in each diagnostic category as compared with total pathological laboratory volume over time, and the age and gender distribution of histopathological diagnostic categories over time.
Results:
Specimens of 746 eyes from 729 pediatric patients were analyzed. Pediatric enucleated eyes constituted 2.7% of all specimens received at the pathology laboratory. The overall frequency of pediatric enucleation specimens did not change over time. Retinoblastoma specimens increased by a factor of 2.9 over time (p < 0.0001). The increase in retinoblastoma was offset by a decrease in nonretinoblastoma enucleations, which decreased by a factor of 3.8 between the 1960s and 2000s (p < 0.0001), driven by a decrease in enucleations caused by trauma (p < 0.0001). Beginning in the 1980s, pediatric enucleations caused by nonrhegmatogenous retinal detachment, nematode and non-nematode endophthalmitis, and congenital glaucoma decreased significantly. Retinoblastoma was the most common diagnosis overall (45%), in girls (60%), and in ages <5 years (78%). Trauma was the second most common diagnosis (32%) and the most common in boys (42%) and in children ages 6-12 (58%) and 13-18 (72%) years.
Conclusions:
A decrease in pediatric nonretinoblastoma enucleations was observed over time, possibly attributable to better diagnostic capabilities, surgical techniques, and public health interventions. The increase in retinoblastoma enucleations over time was likely due to the result of institutional referral bias.
