title: Managing the consequences of aggressive conservative treatment for refractory retinoblastoma with vitreous seeding.
abstract: A 4 year-old girl with bilateral, non-familial retinoblastoma (RB) was referred to our care after primary enucleation OS and active tumor OD refractory to multiple therapies (intravenous chemotherapy, laser/cryotherapy, and I-125 plaque radiotherapy). Vitreous seeding OD, initially controlled by several sessions of Ophthalmic Artery Infusion Chemotherapy (OAIC) and periocular chemotherapy, recurred shortly thereafter. The patient underwent intravitreal (IVit) Melphalan injections achieving tumor control despite the concurrent development of keratopathy, pupillary synechiae, cataract, and necrosis of the inferior fornix and the adjacent orbital fat, all secondary to the treatments administered. Repeated amniotic membrane implants and tarsorrhaphy were performed to alleviate the symptoms. Despite being tumor free for 6 months, a poor fundus view and treatment-related complications prompted us to consider enucleation, but parents declined. Following recent negative magnetic resonance imaging (MRI), her cataract was removed. She was then found to have tumor recurrence. Her eye was enucleated 12 months ago and she recovered well from the surgery. As ocular oncology embarks in eye-preserving treatments for retinoblastoma, it is important to address the cumulative effects and associated impact of such treatments and the possibility of failure.
authors.affiliation: University of Cincinnati Medical School, University of Cincinnati Medical Center, Cincinnati, OH, USA.
authors.forename: Aubrey
authors.initials: A
authors.lastname: Brink
authors.affiliation: University of Cincinnati Medical School, University of Cincinnati Medical Center, Cincinnati, OH, USA.
authors.forename: Zélia Maria
authors.initials: ZM
authors.lastname: Correa
authors.affiliation: University of Cincinnati Medical School, University of Cincinnati Medical Center, Cincinnati, OH, USA.
authors.forename: James
authors.initials: J
authors.lastname: Geller
authors.affiliation: University of Cincinnati Medical School, University of Cincinnati Medical Center, Cincinnati, OH, USA.
authors.forename: Todd
authors.initials: T
authors.lastname: Abruzzo
authors.affiliation: University of Cincinnati Medical School, University of Cincinnati Medical Center, Cincinnati, OH, USA.
authors.forename: James J
authors.initials: JJ
authors.lastname: Augsburger
mesh_terms: D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D015353:Eye Enucleation; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D019572:Retinal Neoplasms / Q000628:therapy*; D012175:Retinoblastoma / Q000628:therapy*