Outcomes of intravitreal melphalan for vitreous seedings in retinoblastoma resistant to systemic chemotherapy

Abstract Purpose To determine the efficacy of intravitreal injection of melphalan for vitreous seedings resistant to systemic chemotherapy. Methods and material Prospective non comparative study investigates 105 consecutive eyes of 105 retinoblastoma patients in a tertiary care hospital. Patients with persistent or recurrent vitreous seeds were included in the study. Injection melphalan was prepared under aseptic conditions. Injection was given at 2–4 mm away from the limbus using 27gauge needle. Cryotherapy was applied at injection site before and during removal of needle. Eye was copiously irrigated soon after the injection to minimize the chances of surface toxicity. After injection intravitreal melphalan, eye pad was applied for 2 h and patients were instructed to instill topical antibiotic and steroid drops for one week. Patients were examined the next day and then weekly till 3rd week. At each follow up, examination under microscope (EUA) and indirect ophthalmoscopy was done. Retinal images were taken using retcam MII for comparison with the previous ones. Results Twenty-five (23.8%) out of 105 eyes showed complete regression of vitreous seeds with one injection of intravitreal melphalan after one month. Thirty-one (29.5%) eyes required further 3 intravitreal injections for complete regression, while thirty-four (32.4%) eyes required further 6 intravitreal injections for complete regression. Fifteen (14.3%) eyes did not show regression of vitreous seeds even after 6 intravitreal injections and were planned for second line chemotherapy. Conclusion Intravitreal injection melphalan shows promising results in the treatment of vitreous seeds in retinoblastoma, resistant to systemic chemotherapy.