title: Intravitreal melphalan for refractory or recurrent vitreous seeding from retinoblastoma.
abstract: OBJECTIVE
  To evaluate the efficacy and complications of intravitreal chemotherapy for viable vitreous seeding from retinoblastoma.
  
  
  METHODS
  Intravitreal injection of melphalan (8-50 μg in 0.05 mL) followed by injection site cryotherapy.
  
  
  RESULTS
  Among 12 treated cases, success with control of vitreous seeds was achieved in 10 of 12 cases at immediate follow-up (0-3 months), 8 of 10 cases at short-term follow-up (3-6 months), and 6 of 10 cases at long-term (>6 months) follow-up. Among those 8 cases that received an 8- to 10-μg dose, control was achieved in 6 of 8 cases at immediate follow-up, 5 of 7 cases at short-term follow-up, and 3 of 7 cases at long-term follow-up. Complications with the 8- to 10-μg dose were minor and included preretinal hemorrhage and retinal vasculitis with retinal pigment epithelial alterations. Of those 4 that received a 50-μg dose, immediate, short-term, and long-term control was 100%, but complications of cataract, vitreous hemorrhage, subretinal hemorrhage, severe hypotonia, and phthisis lead to enucleation in 2 cases. There was no case of orbital tumor recurrence or retinoblastoma metastasis (follow-up range, 8-66 months).
  
  
  CONCLUSIONS
  Intravitreal melphalan for recurrent vitreous seeds from retinoblastoma appears to provide vitreous seed control in some patients. A high dose (50 μg) of melphalan is toxic and should be avoided.
authors.affiliation: Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
authors.forename: Fariba
authors.initials: F
authors.lastname: Ghassemi
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D058449:Intravitreal Injections; D008558:Melphalan / Q000008:administration & dosage* / Q000009:adverse effects; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology; D009366:Neoplasm Seeding; D018714:Radiotherapy, Adjuvant; D019572:Retinal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D012175:Retinoblastoma / Q000188:drug therapy* / Q000556:secondary; D016896:Treatment Outcome; D014822:Vitreous Body / Q000473:pathology*
chemical_list: D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan