What's the diagnosis?
A 2-year-old girl was referred for an abnormal whitening (leukocoria) of the left pupil, as well as a divergent squint (Panel A). Her visual acuity was markedly impaired. Ophthalmologic examination revealed retinal detachment. Computed tomography showed left intraocular calcification (Panel B, arrow).
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Ocular retinoblastoma was diagnosed, and primary enucleation was performed. Histopathological examination showed retinoblastoma without optic-nerve infiltration. At 5 years of follow-up, the patient remains well with neither local recurrence nor involvement of the contralateral eye. Retinoblastoma is the most common primary childhood ocular tumor. The simultaneous bilateral red-reflex test (performed at 4 m) is a useful screening test. Unequal intensity of the red reflexes suggests unequal refractive power, ocular media opacities, or fundus disease. Any divergence in red-reflex intensity warrants referral to an ophthalmologist.
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