We find that the most important diagnostic technique is binocular indirect ophthalmoscopy with meticulous scleral depression, which can demonstrate tumors less than 1 mm in size. Echography may detect lesions as small as 2 mm in size, and has been shown to be 98.4 percent sensitive for retinoblastoma diagnosis. B-scan characteristically demonstrates attenuation or absence of the normal soft tissue echoes in the orbit behind the tumor due to attenuation and reflection of the sound by calcification. Vitreous seeding and areas of hemorrhage are visible. Treatment Modalities Enucleation .
Enucleation remains the most frequent treatment for retinoblastoma.
Indications include unilateral tumors that occupy more than half of the globe, extensive vitreous seeding by the tumor, total retinal detachment, iris neovascularization, ciliary body and iris involvement with the tumor or limited visual potential. With earlier tumor detection, as well as improved and increased usage of more conservative eye-sparing therapeutic methods, the frequency of enucleation has declined significantly over the past 40 years. 15 Radiation . Retinoblastoma is an extremely radiosensitive tumor, and external beam radiotherapy is most often used to treat patients with bilateral retinoblastoma that is not amenable to focal treatment. Radiation therapy has been associated with increased second tumor risk and midface hypoplasia in this population.