The Asia-Pacific Journal of Ophthalmology

Asia-Pacific Journal of Ophthalmology:

Issue 5, September/October 2018 Original Study - Clinical

Optical Coherence Tomography of Small Retinoblastoma

Welch, R. Joel; Rao, Raksha; Gordon, Phillip S.; Say, Emil Anthony T.; Shields, Carol L.

Author Information

From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA.

Reprints: Carol L. Shields, MD, Ocular Oncology Service, 840 Walnut Street, Suite 1440, Philadelphia, PA 19107. E-mail:


Purpose: To investigate hand-held optical coherence tomography (HH-OCT) characteristics of small (<1 mm thickness) retinoblastoma.

Design: Retrospective observational case series.

Methods: Patient and tumor data were extracted from the medical record and analyzed along with HH-OCT scans. Determination of tumor layer of origin was performed using a layer-by-layer analysis of HH-OCT data and specific HH-OCT–related features were described.

Results: There were 20 sub-millimeter retinoblastomas from 16 eyes of 15 patients. Mean largest tumor basal diameter by HH-OCT was 2.2 mm (median, 1.9; range, 0.7–4.1 mm), and mean tumor thickness was 468 μm (median, 441; range, 151–998 μm). In all cases, the retinoblastoma caused discontinuity or disruption of the inner nuclear (INL), outer plexiform (OPL), outer nuclear (ONL), and external limiting membrane (ELM) layers (20/20, 100%). Tumor origin was in the INL in 19/20 (95%) and equivocal (INL vs ONL) in 1/20 (5%). Intratumoral microcalcification was present in 14/20 tumors (70%). There were 2 characteristic findings (signs) on HH-OCT including the INL “fish tail” sign with splaying of the INL at the tumor margin (19/20, 95%) and the ONL “shark fin” sign with folding of the ONL and OPL, conforming to the lateral tumor margins (15/20, 75%). Both signs were concurrently present in 15 tumors (15/20, 75%).

Conclusions: HH-OCT demonstrated that sub-millimeter retinoblastoma seems to originate from the INL, with tumor base and thickness growth progressing in a linear relationship. Characteristic HH-OCT findings included intratumoral microcalcification, INL “fish tail” sign, and ONL “shark fin” sign.

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