Successful treatment of macular retinoblastoma with superselective ophthalmic artery infusion

Purpose To report our experience with superselective ophthalmic artery infusion of Melphalan (SOAIM) for macular retinoblastoma, in order to obtain tumor control while preserving as much as possible useful vision. Methods This report concerns 5 cases with ‘naïve’ unilateral retinoblastoma involving the macula, selected from a group of patients scheduled for SOAIM as the primary treatment. Follow-up ranged from a minimum of 6 months to a maximum of 30 months. Results Each eye of each patient was treated with a cycle of three SOAIM procedures, made of 3-5 mg of Melphalan per eye per treatment. SOAIM procedure was well tolerated in all 5 patients. One of the eyes was also treated with cryotherapy while all eyes underwent transpupillary thermo-therapy and/or argon laser during or after the intra-arterial treatment cycle. All patients are alive and free of metastatic spread. All the eyes achieved ophthalmoscopic remission of the tumor foci, showing types I to III regression, and no enucleation was necessary.Ultrasounds and fluorangiography were performed. Conclusion SOAIM is effective for the treatment of macular retinoblastoma, when performed in adequate settings by operators with skills in angiographic diagnosis and treatment of intracranial vascular diseases. Moreover, Melphalan selectively delivered in the ophthalmic artery may allow the salvation of eyes which should otherwise be enucleated, showing a very low rate of complications due to local and systemic toxicity.