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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThere have been 4 periods in the history of retinoblastoma (Rb) since the 18th century: prehistologic, histologic, enucleation, and irradiation\/chemotherapy. Since 1964, however, there has been an unprecedented rate of progress in research and treatment in Rb. This article discusses the advances that have occurred in Rb over the past 50 years.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EHead \u0026amp; Neck Cancers\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EEye Cancer\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOphthalmology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHead \u0026amp; Neck Cancers\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EEye Cancer\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EHans E. Grossniklaus, MD, Emory University School of Medicine, Atlanta, Georgia, USA, delivered the Jackson Memorial Lecture, in which he discussed the advances that have occurred in retinoblastoma (Rb) over the past 50 years.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EDr Grossniklaus noted that when Edwin P. Dunphy, MD, presented the Jackson Memorial Lecture in 1964, he referred to 4 periods in the history of Rb since the 18th century: prehistologic, histologic, enucleation, and irradiation\/chemotherapy.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ESince 1964, however, there has been an unprecedented rate of progress in research and treatment in Rb. Dr Grossniklaus proposed 3 additional stages of significant advances in this field, as represented by the periods of molecular biology, targeted therapy, and global health awareness.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EMOLECULAR BIOLOGY\u003C\/h2\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EAccording to Dr Grossniklaus, increased knowledge of the genetics and molecular pathogenesis of Rb and mechanisms of its progression have been the most significant contributing factors to the advancement of understanding this tumor in the past 50 years.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EDuring this period, Knudson\u0027s 2-hit hypothesis was a pivotal milestone that explained the relationship between hereditary and nonhereditary forms of Rb. In the hereditary form of the disease, which typically presents as bilateral with multiple tumors, the child inherits one mutation in the \u003Cem\u003ERB\u003C\/em\u003E gene and then acquires a second mutation or hit. However, in the nonhereditary form, cells in the developing retina acquire both mutations. This form usually presents in children at a later age than in the hereditary form, typically arising as a single unilateral tumor.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EDr Grossniklaus noted that additional events are now known to be required for Rb progression [Harbour JW. \u003Cem\u003EInvest Ophthalmol Vis Sci.\u003C\/em\u003E 2006]. The Rb protein recruits additional proteins to binding sites related to transcription factor E2F, resulting in alterations in chromatin structure and preventing transcription from occurring. When Rb is phosphorylated by cyclin-dependent kinases, these proteins unbind, and histone is released from DNA. This allows transcription to proceed, thereby resulting in cell division and proliferation.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EDephosphorylation of Rb leads to cell exit, resulting in differentiation and senescence, and cell cycle exit can also occur in situations of cell stress or hyperproliferation. When Rb is hyperphosphorylated, E2F is released, and the cell undergoes p53-mediated apoptosis.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EDr Grossniklaus described the Rb protein as the \u201cmaster regulator of the cell cycle.\u201d When mutations occur in both alleles of the \u003Cem\u003ERB\u003C\/em\u003E gene, uncontrolled cellular proliferation or retinocytoma formation result, and additional events can occur that result in progression to Rb.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EAdvances have occurred in the pathology of Rb. High-risk histopathologic features have been identified, including optic nerve invasion beyond the lamina cribrosa, massive choroidal invasion in which the tumor is in contact with the sclera for \u2265 3 mm, and a combination of any optic nerve invasion and any choroidal invasion [Sastre X et al. \u003Cem\u003EArch Pathol Lab Med.\u003C\/em\u003E 2009].\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EResults from a recent molecular study showed that Rb can be classified on the basis of its cellular origin [Kapatai G et al. \u003Cem\u003EBr J Cancer\u003C\/em\u003E. 2013]. Group 1 tumors arise in retinal precursor cells, expressing genes found in early retinal development, and group 2 tumors arise later in development from cone precursor cells, expressing genes found after cone development. These findings suggest that the tumor may be stratified by gene expression profile with regard to its clinical behavior and outcome.\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EDr Grossniklaus indicated that recent work in his laboratory has examined the association between (1) tumor anaplasia\u2014an apparent manifestation of the gene expression profile\u2014and (2) the development of metastases and survival in patients with Rb [Grossniklaus HE. \u003Cem\u003EAm J Ophthalmol\u003C\/em\u003E. 2014]. Tumors from 266 patients who underwent enucleation for unilateral Rb were classified as retinocytoma or anaplasia (mild, moderate, or severe). The results of the study showed a significant correlation between anaplasia grade and survival, with patients with severe anaplasia being more likely to develop metastases or die when compared with those with mild or moderate grades (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .01; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/43\/4\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Relationship Between Degree of Tumor Anaplasia and Survival\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1255951051\u0022 data-figure-caption=\u0022Relationship Between Degree of Tumor Anaplasia and Survival\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/43\/4\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/43\/4\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/43\/4\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15498\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-13\u0022 class=\u0022first-child\u0022\u003ERelationship Between Degree of Tumor Anaplasia and Survival\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EAdapted from \u003Cem\u003EAmerican Journal of Ophthalmology\u003C\/em\u003E, 158, Grossniklaus HE, Retinoblastoma. Fifty Years of Progress. The LXXI Edward Jackson Memorial Lecture, 875\u2013891, Copyright 2014, with permission from Elsevier.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ETARGETED THERAPY\u003C\/h2\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EAdvances have been made in the treatment of Rb. According to Dr Grossniklaus, chemotherapy now includes the use of alkylating agents (eg, melphalan), platinum-based antineoplastic agents (eg, carboplatin), topoisomerase inhibitors (eg, etoposide), and vinca alkyloids (eg, vincristine). Chemoreduction for Rb involves intravenous injection of these agents plus focal consolidation of the regressed tumor with laser therapy or cryotherapy. He noted that these advances in globe-salvaging therapies led to the International Classification of Retinoblastoma staging system, which classifies the tumor based on its size and location as well as the presence and location of vitreous seeds (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E) [Murphree AL. \u003Cem\u003EOphthalmol Clin North Am.\u003C\/em\u003E 2005].\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15502\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15502\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15502\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-15\u0022 class=\u0022first-child\u0022\u003EInternational Classification of Retinoblastoma\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EDr Grossniklaus also discussed the use of intra-arterial chemotherapy as a successful treatment option for some patients. In this technique, a catheter is introduced into the opening of the ophthalmic artery, allowing injection of melphalan, topotecan, or carboplatin. Intravitreal chemotherapy has emerged as a safe and successful option, particularly in cases with recalcitrant vitreous seeds of Rb.\u003C\/p\u003E\n         \u003Cp id=\u0022p-18\u0022\u003EHe indicated that work in his laboratory has centered on developing intraocular chemotherapy techniques via a rabbit xenograft model of human Rb [Kang SJ, Grossniklaus HE. \u003Cem\u003EJ Biomed Biotech\u003C\/em\u003E. 2011]. Additional work has involved the technique of suprachoroidal injection with a microneedle that facilitates injection into the suprachoroidal space, enabling delivery of chemotherapeutic agents into the posterior aspect of the eye without entering the vitreous space.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EGLOBAL HEALTH AWARENESS\u003C\/h2\u003E\n         \u003Cp id=\u0022p-19\u0022\u003EDr Grossniklaus described Rb as a \u201cremarkable success story.\u201d Despite being a once-fatal disease, the overall survival for Rb in developed countries has increased in the past 100 years due to significant advances in this field (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/43\/4\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Five-Year Survival Rate in Developed Countries\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1255951051\u0022 data-figure-caption=\u0022Five-Year Survival Rate in Developed Countries\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/43\/4\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/43\/4\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/43\/4\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15499\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-20\u0022 class=\u0022first-child\u0022\u003EFive-Year Survival Rate in Developed Countries\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from HE Grossniklaus, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-21\u0022\u003EHowever, he emphasized that in the current era, global health awareness in Rb is increasing. Although up to 300 new cases of the tumor are diagnosed each year in the United States, \u0026gt; 1000 new patients are identified with Rb annually in China and India. Because the largest population growth in the coming years is projected to occur in Asia, most new cases of Rb will occur in this region [Shields C, Shields JA. \u003Cem\u003ECurr Opin Ophthalmol\u003C\/em\u003E. 2006].\u003C\/p\u003E\n         \u003Cp id=\u0022p-22\u0022\u003EHe shared data demonstrating that, although survival rates for Rb are high in the United States, they decrease to only 40% in developing countries with lower incomes (\u003Ca id=\u0022xref-fig-3-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F3\u0022\u003EFigure 3\u003C\/a\u003E) [Canturk S et al. \u003Cem\u003EBr J Ophthalmol\u003C\/em\u003E. 2010].\u003C\/p\u003E\n         \u003Cdiv id=\u0022F3\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/43\/4\/F3.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Comparison of 5-Year Survival Rates in Retinoblastoma\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1255951051\u0022 data-figure-caption=\u0022Comparison of 5-Year Survival Rates in Retinoblastoma\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 3.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/43\/4\/F3.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/43\/4\/F3.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 3.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/43\/4\/F3.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15500\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 3.\u003C\/span\u003E \n               \u003Cp id=\u0022p-23\u0022 class=\u0022first-child\u0022\u003EComparison of 5-Year Survival Rates in Retinoblastoma\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003ESource: Canturk S et al. \u003Cem\u003EBr J Ophthalmol\u003C\/em\u003E. 2010.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-4\u0022\u003EReproduced with permission from HE Grossniklaus, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-24\u0022\u003EThe main challenge for the future in Rb is therefore a social one that involves ensuring that children in developing low-income regions across the world have access to adequate medical care, Dr Grossniklaus concluded.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F4\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/43\/4\/F4.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022The editors would like to thank the many members of the 2014 Annual Meeting of the American Academy of Ophthalmology presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1255951051\u0022 data-figure-caption=\u0022The editors would like to thank the many members of the 2014 Annual Meeting of the American Academy of Ophthalmology presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure4\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/43\/4\/F4.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/43\/4\/F4.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure4\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/43\/4\/F4.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15501\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\n               \u003Cp id=\u0022p-25\u0022 class=\u0022first-child\u0022\u003EThe editors would like to thank the many members of the 2014 Annual Meeting of the American Academy of Ophthalmology presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference 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