**2.5 Diagnosis**

**Figure 2.** Group V Tumor Left Eye on Presentation (December 2011) The eye was subsequently enucleated.

into 5 groups, labeled A-E, based on the chances that the eye can be saved using current treatment options.

**Group A**

30 Telemedicine

**Group B**

**Group C**

**Group D**

**Group E**

Small tumors away from foveola and disc •Tumors <3mm confined to retina

All other tumors confined to the retina. •Subretinal fluid <3mm from base of tumor

Local subretinal fluid or vitreous seeding

Diffuse subretinal fluid or seeding •Subretinal fluid >6mm from tumor

•Tumor in/on ciliary body •Iris neovascularization •Neovascular glaucoma

•Opaque media from hemorrhage

•Subretinal fluid alone >3mm and <6mm from tumor •Vitreous or subretinal seeding <3mm from tumor

•Vitreous or subretinal seeding >3mm from the tumor

Presence of 1 or more of following poor prognostic features •More than two-thirds of the globe filled with tumor •Tumor in anterior segment or anterior to vitreous

**Table 2.** International Classification of Retinoblastoma

•Located at least 3mm from foveola and 1.5mm from optic disc

The International Classification for Intraocular Retinoblastoma is a newer staging system. It divides intraocular retinoblastomas

Diagnosis is established through a combination of history and physical examination, usually requiring binocular indirect fundoscopy with scleral indentation. This is generally performed under anesthesia to precisely determine the number and location of tumors. An experienced examiner can establish the diagnosis based on the clinical appearance of the tumor. Ancillary diagnostic studies can be helpful if the diagnosis is uncertain. Ultrasonography and computed tomography can demonstrate the mass and detect presence of calcium. Magnetic resonance imaging is of value for assessing the optic nerve, orbit, and brain and evaluating spread outside the globe.
