Introduction / Purpose: Retinoblastoma is the most common intraocular malignancy of infancy and early childhood. In developing countries the decreased access to health care poses a major challenge and increases the possibility of extra-ocular dissemination. Surgical pathological examination aim at discerning histopathological features that pose a higher risk for extraocular spread and are indicative of a need for adjuvant therapy. Our aim is to study the prevalence of histopathological high risk features amongst the enucleated eyes, measure the Event- free survival (EFS) in those patients and compare the EFS in two groups 1) the ones who received adjuvant chemotherapy, 2) the ones who did not. Materials & Methods: We retrospectively analyzed patients who were presented to Children’s Cancer Hospital - Egypt 57357 between July 2007 and April 2012. Only unilateral cases were included in the study. Pathological examination of the enucleated eyes was conducted for all cases. Pathologists were trained for detection of high risk features. Designated high risk features included massive choroidal invasion, retrolaminar invasion or any degree of combined choroidal with optic nerve invasion. Patients were followed up till June 2013. Results: During the period from July 2007 to end of April 2012 a total of 219 patients presented to CCHE-57357 with retinoblastoma. Only 40 patients had unilateral retinoblastoma and had undergone enucleation and their pathology reports revealed high risk features.Three patients have been histopathologically diagnosed with extra-ocular retinoblastoma. Conclusions / Significance: Introducing adjuvant chemotherapy for our cases has improved event-free survival. Only followup with no adjuvant treatment is sufficient for patients with no high risk features. Training pathologists in developing countries on detection of high risk features is a cost-effective measure for improving retinoblastoma integrated management.

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