Abstract

Background: Retinoblastoma is the most common pediatric ocular malignancy, yet data on optic nerve involvement (ONI) in resource limited settings remain scarce.
Objective: To evaluate the clinical and radiological characteristics of pediatric retinoblastoma with ONI and assess survival outcomes.
Methods: This retrospective cohort study included 141 patients diagnosed between January 2018 and January 2023 at Kilimanjaro Christian Medical Centre. ONI was classified anatomically as intraocular, intraorbital, intracanalicular, or intracranial, based on the most posterior extent of involvement. Survival analysis was performed using Cox regression.
Results: Of 141 patients, ONI was detected in 82 (58.2%): intraocular 20 (14.2%), intraorbital 9 (6.4%), intracanalicular 25 (17.7%), and intracranial 28 (19.9%). Patients without ONI had the highest survival, while intracranial ONI was associated with the poorest outcomes. Cox regression showed that advanced ONI and delayed presentation significantly increased mortality risk, while chemotherapy improved survival.
Conclusion: ONI classification based on anatomical extent provides a reproducible framework for assessing disease severity. Delayed presentation and advanced ONI were associated with poorer survival outcomes.

Key words: retinoblastoma, radiological features, optic nerve involvement, predictors of survival