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August 2014

Tethered Vitreous Seeds Following Intravitreal Melphalan for Retinoblastoma

Author Affiliations
  • 1Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
  • 2Department of Ophthalmology, Weill Cornell Medical College, New York, New York
  • 3Department of Ophthalmology, Mount Sinai School of Medicine, New York, New York
  • 4Service of Interventional Neuroradiology, Department of Neurosurgery, Weill Cornell Medical College of New York Presbyterian Hospital, New York, New York
  • 5Service of Interventional Neuroradiology, Department of Neurology and Radiology, Weill Cornell Medical College of New York Presbyterian Hospital, New York, New York
JAMA Ophthalmol. 2014;132(8):1024-1025. doi:10.1001/jamaophthalmol.2014.436

Placing a needle into an eye with retinoblastoma, whether for diagnostic or therapeutic purposes, has historically been avoided owing to concerns of extraocular spread along the needle track.1,2 In the past 3 years, intravitreal injections of melphalan have been used worldwide, with excellent results for vitreous seeding and an exceedingly low risk of extraocular extension.3,4 The treatment course involves repetitive puncture sites with approximately 6 to 8 weekly injections and often a concomitant paracentesis by some groups.3,5 Techniques have been adopted to enhance safety, including reduction of intraocular pressure and cryotherapy of the injection site.5 Despite low documented risk of extraocular extension,4 we describe 2 instances in which active vitreous seeds were drawn toward the ocular surface. While disease did not exit the eye, it did tether to the injection site and eventually regressed with a continuation of treatment.

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