Case Report

Intravitreal chemotherapy in the management of retinoblastoma in a resource-limited setting

Kashmira Rawjee, Teboho Seobi, Aubrey Makgotloe
African Vision and Eye Health | Vol 81, No 1 | a692 | DOI: https://doi.org/10.4102/aveh.v81i1.692 | © 2022 Kashmira Rawjee | This work is licensed under CC Attribution 4.0
Submitted: 15 July 2021 | Published: 11 January 2022

About the author(s)

Kashmira Rawjee, Department of Ophthalmology, Faculty of Neurosciences, University of the Witwatersrand, Johannesburg, South Africa; and, Department of Ophthalmology, Faculty of Neurosciences, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
Teboho Seobi, Department of Ophthalmology, Faculty of Neurosciences, University of the Witwatersrand, Johannesburg, South Africa; and, Department of Ophthalmology, Faculty of Neurosciences, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
Aubrey Makgotloe, Department of Ophthalmology, Faculty of Neurosciences, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa; and, Department of Ophthalmology and Vitreoretinal Service, Faculty of Neurosciences, University of the Witwatersrand, Johannesburg, South Africa


Share this article

Bookmark and Share

Abstract

Intravitreal chemotherapy (IVitC) in the management of retinoblastoma has increased the rate of globe salvage, specifically in patients with recurrent disease and associated vitreous seeds. A significant number of children with retinoblastoma in developing countries present late, resulting in higher intraocular tumour-stage at presentation. Treatment requirements for such tumours usually include intravenous chemotherapy (IVC) and/or intra-arterial chemotherapy (IAC). While IVC has a long usage track record and a good efficacy, it has been reported to be associated with higher recurrence rates in a significant number of patients. Intra-arterial chemotherapy has the advantage of lower recurrence rates but requires personnel with advanced interventional radiology skills and has limited efficacy in treating intravitreal seeds. Intravitreal chemotherapy has gained popularity recently, largely because of its superior efficacy in the management of vitreous seeds, subretinal seeds and recurrent retinal tumour. An 8-month-old male infant initially presented with bilateral retinoblastoma, International Classification System for Intraocular Retinoblastoma (ICRB) Group E in the right eye and Group B on the left eye. The right eye was enucleated and currently has a prosthesis. The left eye had tumours that initially responded to brachytherapy and transpupillary thermotherapy (TTT). Approximately two years later his tumours recurred with vitreous seeds and were successfully managed with the use of cryotherapy and intravitreal chemotherapy. The simplicity of the technique of IVitC and its efficacy in controlling vitreous seeds and recurrent retinal tumours makes this route of regional chemotherapy a viable one in areas with limited expertise and resources such as South Africa.

Keywords

retinoblastoma; ocular oncology; intravitreal chemotherapy; vitreous seeds; melphalan; topotecan

Metrics

Total abstract views: 1263
Total article views: 915

 

Crossref Citations

1. Intravitreal chemotherapy (IVitC): An adjuvant eye salvage modality
Syeed Mehbub Ul Kadir
IP International Journal of Ocular Oncology and Oculoplasty  vol: 8  issue: 2  first page: 91  year: 2022  
doi: 10.18231/j.ijooo.2022.021