Retinal tumour outcome with IVC in retinoblastoma
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Retinoblastoma is the most common paediatric intraocular malignancy. Recently, targeted treatment like intravitreal chemotherapy (ivc) and intra-arterial chemotherapy have become popular for managing advanced intraocular retinoblastoma. Targeted treatment eliminates systemic side effects of treatment while allowing a remarkable increase in the chemotherapy dose delivered to the tumour. Hence, they are more effective and less toxic than the conventional systemic chemotherapy. Most of the studies reported in the literature on ivc in retinoblastoma have studied treatment outcomes in cases of retinoblastoma with recalcitrant or recurrent vitreous seeds. In this study investigated whether ivc can cause retinal tumour regression in cases of retinoblastoma without seeds.

All eyes with retinoblastoma that showed disease progression/relapse in retina with standard intravenous chemotherapy and were planned for enucleation were evaluated for the study. All eyes were administered intravitreal injection of melphalan (20??g in 0.1?ml volume) using safety enhanced technique as described by Munier. Tumour response evaluation was to be done during examination under anaesthesia after 2 weeks of injection, the injection would be repeated till there was complete tumour regression (maximum of six injections) or it became feasible for focal treatment. In case no change or increase in tumour size was noted, the eye would be enucleated.

Five eyes of five retinoblastoma patients were recruited in the study. The mean age was 21.8 months. Three out of five patients had a unilateral disease, while two out of five had bilateral disease (group B in two cases). Tumour response evaluation done within 2 weeks of the intravitreal injection showed no response of the tumour to the ivc in one case, while in four out of five cases tumour showed progression. Enucleation was advised in all cases. Four out of five cases underwent enucleation, while one was lost to follow-up. On histopathological examination of enucleated eyes, no evidence of needle track seeding was noted. No extraocular disease was found on histopathological examination. High-risk features were noted in one case, which were massive choroidal invasion and ciliary body invasion.