title: Intraocular surgery with melphalan irrigation for vitreous hemorrhage in an only eye with retinoblastoma.
abstract: OBJECTIVE
  To illustrate the successful outcome of pars plana vitrectomy (PPV) with melphalan irrigation for vitreous hemorrhage (VH) with suspected viable retinoblastoma. Despite the high risk of intraocular surgery, it was performed to preserve the only potentially seeing eye with treated retinoblastoma.
  
  
  METHODS
  Vitreous hemorrhage occurred in the only eye of a 4-year-old boy after treatment for recurrent multifocal group C retinoblastoma with systemic chemotherapy (carboplatin, etoposide, and cyclophosphamide; and vincristine, cyclophosphamide, and doxorubicin), ruthenium brachytherapy with plaque repositioning, cryotherapy, and external radiotherapy. The VH developed 8 months after repeated brachytherapy with subsequent intravitreal melphalan chemotherapy. The patient's parents refused to remove the eye. The fellow eye was enucleated earlier because of VH and secondary glaucoma, without histologic signs of a viable tumor. Pars plana lensectomy, 25-G vitrectomy with melphalan irrigation (5 μg/mL), and silicone oil tamponade were performed.
  
  
  RESULTS
  No ophthalmoscopic or morphologic signs of a viable tumor were detected. Four months later, the silicone oil was removed. Visual acuity was 20/200 with aphakic correction. Follow-up for 34 months revealed no signs of tumor recurrence or dissemination.
  
  
  CONCLUSIONS
  Despite the high risk of intraocular surgery, the need to preserve the only potentially seeing eye with treated retinoblastoma may require PPV. Thus, in unclear cases of VH with suspected viable tumor, PPV with intraocular melphalan irrigation, with caution, may be a reasonable procedure.
authors.affiliation: Ocular Oncology Department, The S.N. Fyodorov Eye Microsurgery Federal State Institution, Moscow - Russia.
authors.forename: Andrey A
authors.initials: AA
authors.lastname: Yarovoy
authors.affiliation: Head and Neck Tumors Department, SRI of Pediatric Oncology and Hematology of N.N. Blokhin Cancer Research Center RAMS, Moscow - Russia.
authors.forename: Tatyana L
authors.initials: TL
authors.lastname: Ushakova
authors.affiliation: Vitreo-Retinal Department, The S.N. Fyodorov Eye Microsurgery Federal State Institution, Moscow - Russia.
authors.forename: Ilya M
authors.initials: IM
authors.lastname: Gorshkov
authors.affiliation: Head and Neck Tumors Department, SRI of Pediatric Oncology and Hematology of N.N. Blokhin Cancer Research Center RAMS, Moscow - Russia.
authors.forename: Vladimir G
authors.initials: VG
authors.lastname: Polyakov
authors.affiliation: Ocular Oncology Department, The S.N. Fyodorov Eye Microsurgery Federal State Institution, Moscow - Russia.
authors.forename: Olesya V
authors.initials: OV
authors.lastname: Golubeva
authors.affiliation: Head and Neck Tumors Department, SRI of Pediatric Oncology and Hematology of N.N. Blokhin Cancer Research Center RAMS, Moscow - Russia.
authors.forename: Olga V
authors.initials: OV
authors.lastname: Gorovtsova
authors.affiliation: Ocular Oncology Department, The S.N. Fyodorov Eye Microsurgery Federal State Institution, Moscow - Russia.
authors.forename: Olga S
authors.initials: OS
authors.lastname: Krivovyaz
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001918:Brachytherapy; D016190:Carboplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D017679:Cryotherapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D003606:Dacarbazine / Q000627:therapeutic use; D058450:Endotamponade; D005047:Etoposide / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D008558:Melphalan / Q000008:administration & dosage*; D019572:Retinal Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D012175:Retinoblastoma / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D012827:Silicone Oils; D007507:Therapeutic Irrigation; D014750:Vincristine / Q000627:therapeutic use; D014792:Visual Acuity; D014821:Vitrectomy; D014823:Vitreous Hemorrhage / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*
chemical_list: D018906:Antineoplastic Agents, Alkylating; D012827:Silicone Oils; D014750:Vincristine; D005047:Etoposide; D003606:Dacarbazine; D003520:Cyclophosphamide; D016190:Carboplatin; D008558:Melphalan