Figure 1: Inclusion and Exclusions Figure 1: Inclusion and Exclusions. Included Posterior pole retinoblastoma after chemotherapy were (a) juxtafoveal tumors (yellow outline) encroaching on the fovea with preserved foveal pit (Yellow arrow) without underlying tumor documented by OCT and (b) Perifoveal tumors (Blue Outline) encroaching the fovea with loss of foveal pit (right) or preserved foveal pit and underlying tumor (left) documented on OCT. Excluded posterior pole retinoblastoma after chemotherapy were (c) foveal tumors (Green outline) without potential visual salvage due to total involvement of a 2 DD circle circumference centered over the yellow pigment or (d) extrafoveal tumors (Red outline) with excellent potential visual outcome due to non involvement of the 2 DD circle.

Figure 2: Sequential laser crescent method Figure 2: Sequential laser crescent method. Initially (yellow outline), Laser photocoagulation using 532 nm argon laser of crescent-shaped anti-foveal edge (C1) including outer tumor boundary with the adjacent retina. A slightly smaller crescent shaped tumor area (C2) inner to C1, moving closer to the fovea, was photocoagulated using 810 nm diode laser. The fovea is avoided. In subsequent treatment (green outline), scarring of outer boundary is noted and the same procedure of laser photocoagulation (C1 and C2) is repeated as in initial session but smaller crescents were usually treated. The same treatment sequence was used until either a flat scar or totally calcified lesion or a combination of both is reached (blue outline). OCT section across the green line showed the preserved foveal pit (yellow arrowhead) without underlying tumor with retinoschisis between retinal layers overlying the calcific tumor. C1 C2

Figure 3: Outcome of SLC with juxtafoveal tumors Figure 3: Outcome of SLC with juxtafoveal tumors. Yellow box shows an eye with fish-flesh regressed juxtafoveal tumor (upper row) after 4 cycles of systemic chemotherapy. OCT scan (green line) showed preserved foveal pit (yellow arrowhead) without underlying tumor. After conclusion of SLC (lower row), all fish flesh regressed tumor were replaced by flat scarring except in calcified parts. The foveola tumor distance (red line) is shown to increase post SLC. The Red box shows another eye with Juxtafoveal tumor that was successfully managed with SLC with preserved foveal pit and increased foveola tumor distance.

X * Figure 4: Recurrences in SLC of perifoveal tumors. Yellow box shows an eye with a fish-flesh regressed perifoveal tumor where the vertical and horizontal OCT scans (left column) localized the foveal center (yellow arrowhead) over the tumor. The 2 DD circle showed an area of perifoveal retina free of tumor and of potential good visual outcome if saved. SLC was performed with tumor scarring and flattening in the upper half and tumor regrowth in the lower half (middle row). The tumor regrowth can be easily perceived in relation to the three vessels crossing over the tumor marked with (*). Tumor recurrence was treated with 4 cycles of IAC and more laser sessions in the area of the green OCT scan. Tumor reduction was noticed with preserved fovea and reduced subretinal tumor documented by OCT. retinoschisis within the retinal layers can be seen by the OCT. Red box shows another recurrence (X) in a perifoveal tumor that failed IAC and plaque irradiation and the eye was eventually enucleated due to resistant tumor.

Figure 5: secondary macular changes after SLC treatment Figure 5: secondary macular changes after SLC treatment. a-c) Retinoschisis was the most common secondary change were perifoveal retinal layers showed retinoschisis in both juxtafoveal (a-b) and perifoveal tumors (c). Other changes included d) foveal atrophy and e) loss of foveal contour secondary to epiretinal membrane. Loss of the photoreceptor inner segment outer segment (IS-OS) junction was noted in 64% of juxtafoveal tumors (a, b and d) while 36% showed preserved Is-OS junction (e). (f) regressed tumor with overlying preserved fovea and retinal layers that show retinoschisis with minimal sub retinal fluid collection. The final visual acuity in these eyes was 0.1, 0.4, 0.25, 0.16, 0.5 and 0.05 respectively.