ACCORDING to the Department of Health (DOH), cancer ranks third among the leading causes of morbidity and mortality in the Philippines, after infectious and cardiovascular diseases.1 The DOH–Rizal Cancer Registry and the Philippine Cancer Society–Manila Cancer Registry listed breast cancer as the most commonly diagnosed type of cancer in 2006. The Cancer Institute of the University of the Philippines–Philippine General Hospital (UP-PGH) also reported breast cancer as the most common carcinoma seen at the outpatient clinic, with more than 10,000 cases each year. Although intraocular metastasis most frequently originates from the breast,2 it was once a rarity overall. Perls was the first to describe intraocular metastasis in 1872,3 and a subsequent article by Godtfredsen reported its incidence at 0.07%.4 However, post-mortem studies have shown that among patients who died of cancer, 12.2% had histopathologic evidence of intraocular metastases.5 This was supported by another study involving donor eyes with a prevalence of 12.6%.6 Two studies determined the frequency of intraocular metastases from breast carcinoma. Mewis and Young7 examined 250 patients with breast carcinoma and detected 67 (26.8%) positive cases. They also reported that 9% of patients who were asymptomatic also had intraocular metastases. Wiegel and colleagues performed a prospective screening program for 120 asymptomatic patients with disseminated breast carcinoma and found 6 (5%) with intraocular metastases.8 These studies showed that metastases to the eye may not be as rare as once thought.
Breast Neoplasm

Objective: This study determined the clinical characteristics of retinoblastoma (RB) from 1998 to 2008 and compared the epidemiological and clinical patterns with those of the period from 1967 to 2001. Methods: We reviewed the clinical records of 152 patients with RB from 1998 to 2008 in terms of demographic and ophthalmological data and clinical staging or classification. Results: Sixty-three percent of cases were unilateral and 37% were bilateral. Three (3%) of 95 unilateral cases and 7 (12%) of 57 bilateral cases had family history of RB (p = 0.038). The mean age at onset was 17.8 months for unilateral and 7.4 months for bilateral cases, while the mean age at diagnosis was 26.4 months and 13.7 months respectively. The delay from onset to diagnosis was 69% in unilateral and 56% in bilateral RB groups. Financial cost (71.4%) was the leading reason for delay, followed by misdiagnosis (24.5%), and inaccessibility of medical facility (2.0%). The most common manifestations were leukocoria (77%), extraocular findings of orbital mass (9%), and proptosis (6%). Advanced intraocular stage was seen in 63 – 71.6% among those with unilateral and 56 – 60% in those with bilateral tumor. Conclusion The onset of disease had not changed over the years, but patients in general were brought earlier for consultation. Most cases presented in the advanced stage. Decreasing the occurrence of extraocular RB through early consultation and treatment can improve patient survival.
Retinoblastoma ; Epidemiology

Background: Intravitreal chemotherapy has been an effective addition in treating vitreous seeding in retinoblastoma. However, it was only in 2020 that it was used in the Philippines. There is no literature on its use in multiple Filipino retinoblastoma patients. Objectives: To describe the clinical course of the four patients who are the first to undergo intravitreal chemotherapy for vitreous seeding of retinoblastoma in the Philippine tertiary hospital. Methods: A case series of four eyes of four patients with retinoblastoma who underwent intravitreous injection of melphalan and topotecan for vitreous seeding at the Department of Ophthalmology and Visual Sciences of a Philippine tertiary hospital. Results: Two eyes, with International Intraocular Retinoblastoma Classification (IIRC) Group C with vitreous seeding, responded well to intravitreous melphalan and topotecan. One eye had recurrent vitreous seeding despite 10 intravitreal injections. One eye with IIRC Group E, did not respond to intravitreous chemotherapy and was eventually enucleated. This is the first case series on the local use of intravitreous chemotherapy in the country for vitreous seeding in retinoblastoma. The control of 50% achieved in this case series is lower than in other series due to longer treatment interval from poor follow-up and the presence of advanced disease. Conclusion The use of intravitreous melphalan and topotecan can be an effective adjuvant for systemic chemotherapy in controlling vitreous seeding in eyes with IIRC Group C. It is not effective in controlling IIRC Group E disease.
intravitreous ; melphalan ; topotecan ; retinoblastoma ; Philippines

Retinoblastoma

Objective: To describe the clinicopathologic features and outcome of a patient with epithelial-myoepithelial carcinoma of the lacrimal gland who underwent modified lateral orbitotomy with en toto removal of the lesion and adjuvant radiotherapy. Methods: This is a case report. Results: A 31-year-old Filipino male seafarer presented with a 2-month history of an enlarging left superotemporal orbital mass and inferonasal displacement of the globe. Magnetic resonance imaging revealed a superotemporal extraconal mass within the lacrimal sac fossa with evidence of osseous infiltration of the superolateral orbital rim. Modified lateral orbitotomy was performed with en toto removal of the lesion and the clinically infiltrated adjacent lateral bony margin. Histopathologic diagnosis of epithelial-myoepithelial carcinoma of the lacrimal gland was made based on the classic and distinct biphasic morphology and was confirmed with immunohistochemistry studies (cytokeratin-7, S-100, and p63). Systemic surveillance using positron emission tomography and computed tomography scan with contrast revealed no evidence of regional or distant metastasis. Adjuvant radiotherapy of the orbital area was performed for increased local control. Twelve months postoperatively, the patient showed no evidence of tumor recurrence. Conclusion Epithelial-myoepithelial carcinoma of the lacrimal gland is a rare condition, and this is the first documented case from the Philippines. Accurate diagnosis is necessary for appropriate treatment. It should be included in the differential diagnosis of infiltrative lesions in the lacrimal gland fossa.
Lacrimal Apparatus