Late-Onset Bilateral Retinoblastoma in Adolescence with Successful Globe Salvage

Retinoblastoma (RB) is the most common intraocular malignancy in children, known to occur within 5 years of age. The occurrence of RB after the first decade of life is rare and is usually unilateral. Owing to its varied and delayed presentation with advanced stages, enucleation is advocated in most cases of late-onset RB. However, with the advent of multiple treatments, such as local therapies, the chances of globe salvage can still be attempted, even in late-onset RB.

We report a case of a 14-year-old boy who had active RB in the right eye and retinomas in the left eye. The child was given systemic three-drug chemotherapy (standard VEC regimen) along with intravitreal injection of topotecan for vitreous seeds in the right eye and cryotherapy for the retinomas in the left eye. By 1 year, the right eye lesion had shown stable type II regression and no recurrence of vitreous seeds, while the left eye lesions showed type IV regression.

This case highlights a case of bilateral late-onset RB with a rare combination of active RB in one eye and retinoma in the other eye. Successful globe salvage was achieved by combining local and systemic approaches, resulting in good anatomical and functional outcomes.