Superselective intra-arterial chemotherapy complications in advanced retinoblastoma

Purpose The purpose of this study is to report the complications of superselective intra-arterial chemotherapy with melphalan in children undergoing treatment for advanced intraocular retinoblastoma. Methods 49 eyes of 43 children with advanced intraocular retinoblastoma (Reese-Ellsworth Group Vb or International Classification Group D) were treated with superselective intra-ophthalmic artery infusion of melphalan. 22 eyes of 43 children were first diagnosis. 27 eyes of 43 children had previously failed traditional management with systemic chemotherapy and focal therapies and underwent intra-ophthalmic artery infusion of melphalan as an alternative option to enucleation. Serial complications RETCAM images were collected. Results Ophthalmic artery cannulation was successfully performed in 49 eyes of 43 patients. 9 eyes out of 43 (20.9%) patients were enucleated. 4 eyes out of 43 (9.3%) patients were lost to follow-up. No severe systemic side effects occurred. Grade III neutropenia was seen in 3 patients (0.6%). No transfusions were required. 25 (58.1%) patients developed eyelid hyperaemia, 10 (23.2%) frontal region skin rash, 12 (27.9%) emiptosis, 6 (13.9%) eyelid edema, 2 (4.6%) frontal alopecia, 2 (4.6%) eyelashes loss, 2 (4.6%) chorioretinal atrophy, 1 (2.3%) acute ischemic optic neuropathy, all resolved spontaneously. 1 case (2.3%) with permanent ptosis underwent surgery. 1 case (2.3%) presented Roth’s spots. Conclusion Ophthalmic intra-arterial infusion with melphalan is a promising globe-conserving treatment option in advanced retinoblastoma cases with minimal systemic side effects.