To the Editor We read the article by Ghassemi et al1 about the combination treatment with intravitreal melphalan hydrochloride and topotecan hydrochloride for resistant vitreous seeds with great interest. The 3 main practical concerns regarding the rationale for this therapy include the following: (1) the primary question, ie, does the need for such a regimen really exist? (2) the potential increased toxic effects of both drugs combined on the retina and photoreceptors; and (3) the risk of malignancy and surgery-related complications due to multiple injection sites.
Ramanjulu R, Palanivelu MS. Is Combination Therapy for Resistant Vitreous Seeds Really Essential?. JAMA Ophthalmol. 2015;133(2):231-232. doi:10.1001/jamaophthalmol.2014.4638