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By Dr Supreme Goel
Chaithanya eye hospital and research institute Trivandrum Kerala
Co-author(s): Dr Manoj S, Head of department of Retina and Vitreous, Chaithanya Eye Hospital and Research Institute, Trivandrum, Kerala - Uploaded on Mar 25, 2026.
- Last modified by Joshua Friedman on Mar 25, 2026.
- Rating
- Appears in
- Retinoblastoma
- Condition/keywords
- retinoblastoma
- Photographer
- Dr Supreme Goel
- Imaging device
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Fundus camera
Optos ultra-wide field color fundus photography - Description
- An ominous white reflex conceals an aggressive intraocular malignancy. This ultra wide-field fundus image of the right eye demonstrates advanced intraocular disease in a 7-year-old boy, consistent with Group E retinoblastoma, representing the most severe group in the International Classification of Intraocular Retinoblastoma. The retina is largely replaced by a lobulated yellow-white tumor mass with areas of hemorrhagic necrosis and tumor breakthrough, indicating aggressive behavior. There is extensive subretinal seeding. Vitreous seeds are seen as multiple scattered opacities producing a characteristic cloud-like appearance. A significant exudative retinal detachment is present, with elevation and distortion of normal retinal architecture. Dilated and tortuous retinal vessels course over the lesion. The patient was initially referred as Coats disease—a known diagnostic pitfall in such advanced presentations. The tumor extends anteriorly, with tumor cells noted in the anterior chamber, signifying advanced intraocular spread. These features define Group E disease—where even with a visual acuity of 6/9 due to relative macular sparing, the eye is unsalvageable and primary enucleation is required to prevent extraocular extension and metastasis. This image reinforces a vital message: while the eye may be lost, early detection can be life-saving—highlighting the importance of recognizing leukocoria and ensuring timely intervention.
