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Comment & Response
February 2015

Is Combination Therapy for Resistant Vitreous Seeds Really Essential?—Reply

Author Affiliations
  • 1Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
  • 2Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania
JAMA Ophthalmol. 2015;133(2):232-233. doi:10.1001/jamaophthalmol.2014.4657

In Reply We appreciate the thoughtful comments of Ramanjulu and Palanivelu. We agree that intravenous or intra-arterial chemotherapy can often control vitreous seeds from retinoblastoma. Furthermore, we agree that single-agent intravitreal melphalan can control vitreous seeds in most cases.1-4 However, a void remains in which single-agent intravitreal chemotherapy has been unsuccessful2 despite multiple injections with increasing or recurrent vitreous malignancy.2 In these cases, we consider 2-agent chemotherapy of melphalan and topotecan. It could be dangerous to inject single-agent therapy in such cases and delay ultimate success, especially if we trust that the previous injection was appropriately performed. Multiple-agent chemotherapy for other cancers is the rule, not the exception.

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