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A 2-month-old baby boy presented with decreased red reflex and multifocal retinoblastomas in both eyes. After 6 cycles of intravenous chemotherapy and 2 cycles of intra-arterial chemotherapy, in addition to transpupillary thermotherapy, all tumors showed regression. In the right eye, 4 circumscribed regressed retinoblastoma scars were noted. A tiny invisible type 0 regressed retinoblastoma (Figure, A; arrowhead), not seen in color fundus photography or fluorescein angiography, was noted by intraoperative infrared reflectance imaging and spectral-domain optical coherence tomography (OCT; iVue, Optovue Inc). The OCT depicted a circumscribed ovoid hyperreflective mass in the outer nuclear layer (Figure, B). Scattered foci of intralesional hyperreflectivity were seen. This regressed lesion remained stable during 5 months of monitoring with OCT.
Saktanasate J, Vongkulsiri S, Khoo CTL. Invisible Retinoblastoma. JAMA Ophthalmol. 2015;133(7):e151123. doi:10.1001/jamaophthalmol.2015.1123