title: Hemorrhage as a sign of treatment failure after intra-arterial chemotherapy in retinoblastoma.
abstract: Intra-arterial melphalan chemotherapy (IAC) continues to demonstrate excellent utility in the treatment of retinoblastoma. We present the case of a 3-month-old boy diagnosed with with unilateral, advanced stage 5B retinoblastoma and a Coats' response in the right eye. After laser therapy he received 3 doses of IAC. Intraretinal hemorrhaging, first noted after the second dose and worsening after the third, preceded complex exudative retinal detachment. With little visual potential and evidence of atropy, the eye was enucleated. This case illustrates that intraretinal hemorrhage may serve as an early predictor of treatment failure.
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida. Electronic address: Ruwansilva2002@gmail.com.
authors.forename: Ruwan A
authors.initials: RA
authors.lastname: Silva
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida.
authors.forename: Sander R
authors.initials: SR
authors.lastname: Dubovy
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida.
authors.forename: Ditte
authors.initials: D
authors.lastname: Hess
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida.
authors.forename: Rick
authors.initials: R
authors.lastname: Stratton
authors.affiliation: Murray Ocular Oncology and Retina, 6705 Red Road, Miami, Florida.
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Murray
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D015353:Eye Enucleation; D006801:Humans; D007223:Infant; D007261:Infusions, Intra-Arterial; D008297:Male; D008558:Melphalan / Q000008:administration & dosage*; D009366:Neoplasm Seeding; D009367:Neoplasm Staging; D012163:Retinal Detachment / Q000175:diagnosis; D012166:Retinal Hemorrhage / Q000175:diagnosis*; D019572:Retinal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D012175:Retinoblastoma / Q000188:drug therapy* / Q000473:pathology; D017211:Treatment Failure; D014792:Visual Acuity; D014822:Vitreous Body / Q000473:pathology
chemical_list: D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan