Pushing the limit: Globe salvage of Group D retinoblastoma with severe vitreous seeding with intra-arterial chemotherapy and 15 cycles of intravitreal chemotherapy

Eugenia C Greig; Roxanna Rabiee; Armin R Afshar

doi:10.1016/j.ajoc.2023.101987

Pushing the limit: Globe salvage of Group D retinoblastoma with severe vitreous seeding with intra-arterial chemotherapy and 15 cycles of intravitreal chemotherapy

Am J Ophthalmol Case Rep. 2023 Dec 28:33:101987. doi: 10.1016/j.ajoc.2023.101987. eCollection 2024 Mar.

Authors

Eugenia C Greig¹, Roxanna Rabiee¹, Armin R Afshar^{1

2}

Affiliations

¹ Ocular Oncology Service, Department of Ophthalmology, Wayne & Gladys Valley Center for Vision, University of California, San Francisco, CA, USA.
² Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.

Abstract

Purpose: To report the successful treatment of persistent retinoblastoma vitreous seeding with 6 cycles of intra-arterial chemotherapy and 15 cycles of intravitreal chemotherapy injections.

Observations: A three-year-old female presented to the ocular oncology clinic with Group D retinoblastoma with severe vitreous seeding. The patient received 3 cycles of intra-arterial chemotherapy (melphalan, topotecan, and carboplatin) and 15 cycles of intravitreal chemotherapy (melphalan and combined melphalan/topotecan). Complete tumor regression and resolution of vitreous seeding was achieved. The best corrected visual acuity in the affected eye was 20/50.

Conclusions and importance: Intravitreal chemotherapy for retinoblastoma vitreous seeding is often restricted to 8 treatment cycles. Patients who do not respond after 8 cycles face salvage therapy with radiation or enucleation. This is a case in which prolonged intravitreal chemotherapy delivery was well tolerated and resulted in sustained tumor remission, with useful visual acuity in the treated eye.

Keywords: Intravitreal chemotherapy; Melphalan; Retinoblastoma; Topotecan; Vitreous seeds.

Publication types

Case Reports