In Reply We appreciate the interest in our Observation and the opportunity to answer these thoughtful questions. First, we used intravitreal melphalan to treat the ciliary body tumor, whereas we used intracameral topotecan to treat the anterior chamber seeds.
Second, we tried to minimize the risk of tumor spread at the limbal injection site by using a small volume (0.015 mL) to minimize fluid egress, a 35-gauge needle to form a small, self-sealing wound; a cotton tip placed at the injection site as the needle was withdrawn; and copious irrigation with sterile (hypotonic) water to rupture any tumor cells that may have escaped the eye.1 In addition, the needle was inserted away from the seeds. We prefer to avoid cryotherapy in the limbal area because it can have adverse effects on the cornea. Further, we did not see any indication for adjuvant systemic chemotherapy in this setting because local therapy was successful.
Harbour JW, Paez-Escamilla M. Anterior Chamber Chemotherapy in Retinoblastoma—Necessary But Not Sufficient for Aqueous Seeding Control—Reply. JAMA Ophthalmol. 2018;136(5):597. doi:10.1001/jamaophthalmol.2018.0639
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