Blue Toe Syndrome: A Complication of Intra-arterial Technique, Not Intra-arterial Chemotherapy for Retinoblastoma

To the Editor We read with interest the letter by Sarici et al titled “Blue Toe Syndrome as a Complication of Intra-arterial Chemotherapy for Retinoblastoma.”¹ There is a critical distinction to be made between morbidity related to the administration of intra-arterial chemotherapy (IAC) itself—potential direct retinal chemical toxic effects leading to vision loss, for example—and morbidity related to technical mishaps that occur during or after cerebral angiography in infants. The IAC-related morbidity needs to be weighed carefully in considering the risks and benefits of this technique against other treatment modalities such as intravenous chemotherapy, radiation, or enucleation. However, angiographic mishaps are another thing altogether.