Balmer and Munier second examination, further investigations at a reference center may be required. Conclusions Many ocular conditions in childhood may mimic retinoblas- toma, either by similar ﬁrst signs, leukocoria in particular, similar clinical features, or by comparable evolutive com- plications. Correct diagnosis without delay is imperative as retinoblastoma puts a child’s vision, and indeed life, in danger (Goddard et al 1999; Wallach et al 2006). Early treatment is and will remain the best possible treatment for this highly malignant tumor. Keeping in mind a possible diagnosis of retinoblastoma is the ﬁrst major step to a full recovery. Early diagnosis concerns everybody in contact with the child, the parents, family/friends, nurses, the family doc- tor, often ﬁrst to be confronted with the initial signs, also specialists and reference centers. Leukocoria, or any other unexplained ocular sign in an infant should always, until proved otherwise, invoke the possibility of a malignant tumor and put in motion all the necessary means for prompt diagnosis. References Abramson DH. 1999. Second nonocular cancers in retinoblastoma: a uniﬁed hypothesis. The Franceschetti Lecture. Ophthalmic Genet, 20:193–204. Abramson DH, Beaverson K, Sangani P, et al. 2003. Screening for reti- noblastoma: presenting signs as prognosticators of patient and ocular survival. Pediatrics, 112:1248–55. Abramson DH, Frank CM, Susman M, et al. 1998. Presenting signs of retinoblastoma. J Pediatr, 132:505–8. Abramson DH, Melson MR, Dunkel IJ, et al. 2001. Third (fourth and ﬁfth) nonocular tumors in survivors of retinoblastoma. Ophthalmology, 108:1868–76. Aerts I, Lumbroso-Le Rouic L, Gauthier-Villars M, et al. 2006. Retinoblas- toma. Orphanet J Rare Dis, 1:31. Andersen SR. 1962. Medulloepithelioma of the retina. Int Ophthalmol Clin, 2:483–506. [Anon]. 1987. An international classiﬁcation of retinopathy of prematurity. II. The classiﬁcation of retinal detachment. The International Committee for the Classiﬁcation of the Late Stages of Retinopathy of Prematurity. Arch Ophthalmol, 105:906–12. Apushkin MA, Shapiro MJ, Mafee MF. 2005. Retinoblastoma and simulating lesions: role of imaging. Neuroimaging Clin N Am, 15:49–67. Augsburger JJ, Oehlschlager U, Manzitti JE. 1995. Multinational clinical and pathologic registry of retinoblastoma. Retinoblastoma International Collaborative Study report 2. Graefes Arch Clin Exp Ophthalmol, 233:469–75. Balmer A, Gailloud C, Munier F, et al. 1994. [Unusual presentation of retinoblastoma]. Klin Monatsbl Augenheilkd, 204. Balmer A, Gailloud C, Uffer S, et al. 1988. [Retinoblastoma and pseudoreti- noblastoma: diagnostic study]. Klin Monatsbl Augenheilkd, 192. Balmer A, Munier F. 2002a. Rétinoblastome: diagnostic. In: Zografos L ed. Tumeurs intraoculaires. Paris: Société Française d’Ophtalmologie et Masson. p 485–533. 438 Balmer A, Munier F. 2002b. Rétinoblastome: Epidémiologie. In: Zografos L ed. Tumeurs intraoculaires. Paris: Société Française d’Ophtalmologie et Masson. p 481–5. Balmer A, Zografos L, Uffer S, et al. 2005. Maladie de Coats et télangiec- tasies primaires et secondaires. In: Médico-Chirurgicale E ed. Ophtal- mologie. Paris: Elsevier SAS. p 21–240–E–30. Binder PS. 1974. Unusual manifestations of retinoblastoma. Am J Oph- thalmol, 77:674–9. Black GC, Perveen R, Bonshek R, et al. 1999. Coats’ disease of the retina (unilateral retinal telangiectasis) caused by somatic mutation in the NDP gene: a role for norrin in retinal angiogenesis. Hum Mol Genet, 8:2031–5. Bornfeld N, Schuler A, Boloni R, et al. 2006. [Retinoblastoma]. Ophthal- mologe, 103:59–76; quiz 77–8. Broughton WL, Zimmerman LE. 1978. A clinicopathologic study of 56 cases of intraocular medulloepitheliomas. Am J Ophthalmol, 85:407–18. Brückner R. 1962. Exakte Strabismusdiagnostik bei 1/2–3 jährigen Kindern mit einem einfachen Verfahren, dem “Durchleuchtungstest”. Ophthal- mologica, 149:184–98. Coats G. 1908. Forms of retinal diseases with massive exudation. Roy Lond Ophthalmol Hosp Rep, 17:440–525. Cryotherapy for Retinopathy of Prematurity Cooperative Group. 2001. Multicenter Trial of Cryotherapy for Retinopathy of Prematu- rity: ophthalmological outcomes at 10 years. Arch Ophthalmol, 119:1110–8. de Leon JM, Walton DS, Latina MA, et al. 2005. Glaucoma in retinobla- stoma. Semin Ophthalmol, 20:217–22. De Potter P, Shields JA, Shields CL. 1994. Clinical variations of trilateral retinoblastoma: a report of 13 cases. J Pediatr Ophthalmol Strabismus, 31:26–31. DerKinderen DJ, Koten JW, Tan KE, et al. 1990. Parental age in sporadic hereditary retinoblastoma. Am J Ophthalmol, 110:605–9. Dollfus M-A, Auvert B. 1953. Le gliome de la rétine (rétinoblastome) et les pseudogliomes. Etude clinique, génétique et thérapeutique. Paris: Société française d’Ophtalmologie. Dutton JJ. 1994. Gliomas of the anterior visual pathway. Surv Ophthalmol, 38:427–52. Early Treatment For Retinopathy Of Prematurity Cooperative. 2003. Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial. Arch Ophthalmol, 121:1684–94. Gallie BL, Ellsworth RM, Abramson DH, et al. 1982. Retinoma: spon- taneous regression of retinoblastoma or benign manifestation of the mutation?. Br J Cancer, 45:513–21. Girard B, Le Hoang P, D’Hermies F, et al. 1989. Le rétinoblastoma inﬁltrant diffus. J Fr Ophtalmol, 12:369–81. Goddard AG, Kingston JE, Hungerford JL. 1999. Delay in diagnosis of retinoblastoma: risk factors and treatment outcome. Br J Ophthalmol, 83:1320–3. Goldberg MF. 1997. Persistent fetal vasculature (PFV): an integrated inter- pretation of signs and symptoms associated with persistent hyperplastic primary vitreous (PHPV). LIV Edward Jackson Memorial Lecture. Am J Ophthalmol, 124:587–626. Halperin EC. 2000. Neonatal neoplasms. Int J Radiat Oncol Biol Phys, 47:171–8. Hamelin N, Becquet F, Dureau P, et al. 2000. Particularités cliniques des gliomes du chiasma. Etude rétrospective sur une série de 18 patients. J Fr Ophtalmol, 23:694–8. Howard GM, Ellsworth RM. 1965a. Differential diagnosis of retinoblastoma. A statistical survey of 500 children. I. Relative frequency of the lesions which simulate retinoblastoma. Am J Ophthalmol, 60:610–8. Howard GM, Ellsworth RM. 1965b. Differential diagnosis of retinoblas- toma. A statistical survey of 500 children. II. Factors relating to the diagnosis of retinoblastoma. Am J Ophthalmol, 60:618–21. Kivelä T. 1999. Trilateral retinoblastoma: a meta-analysis of hereditary reti- noblastoma associated with primary ectopic intracranial retinoblastoma. J Clin Oncol, 17:1829–37. Clinical Ophthalmology 2007:1(4)