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.
Francis JH, Marr BP, Brodie SE, Gobin YP, Abramson DH. Tethered Vitreous Seeds Following Intravitreal Melphalan for Retinoblastoma. JAMA Ophthalmol. 2014;132(8):1024–1025. doi:10.1001/jamaophthalmol.2014.436