Combined intravitreal melphalan and intravenous/intra-arterial chemotherapy for retinoblastoma with vitreous seeds

  • Ji Hwan Lee
  • Jung Woo Han
  • Seung Min Hahn
  • Chuhl Joo Lyu
  • Dong Joon Kim
  • Sung Chul LeeEmail author



We aimed to evaluate the therapeutic effect and complications of combined intravitreal melphalan and intravenous/intra-arterial chemotherapy as a primary approach for retinoblastoma with vitreous seeds.


In this retrospective case series, eight eyes from eight retinoblastoma patients with vitreous seeds were included. All eyes received 20–30 μg of intravitreal melphalan accompanied by intravenous and intra-arterial chemotherapy. Triple freeze-thaw cryotherapy was performed when withdrawing the needle from the eye to prevent tumor dissemination.


Tumors and vitreous seeds regressed in all eyes. The mean number of intravitreal melphalan injections was 3.25 (median 3.50, range 2–4). Globe salvage was attained in seven of eight eyes (87.5 %). Enucleation was performed in one case, in which the pathologic section showed no residual tumor and tumor-free resection margins. Serous retinal detachment was observed in four eyes (50 %), and vitreous hemorrhage developed in two (25 %). Retinal pigment epithelium atrophy or mottling was found in three eyes (37.5 %). There were no cases of extraocular tumor extension or remote metastasis.


Combined intravitreal melphalan and intravenous/intra-arterial chemotherapy was effective for tumor and vitreous seeding control, but vision-threatening complications such as vitreous hemorrhage or serous retinal detachment occurred in half the cases.


Combined modality therapy Intravitreal injections Melphalan Neoplasm seeding Retinoblastoma 


Compliance with ethical standards



Conflicts of interest

The authors declare that they have no conflict of interest. All authors certify that we have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

For this type of study formal consent is not required.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Ji Hwan Lee
    • 1
  • Jung Woo Han
    • 2
  • Seung Min Hahn
    • 2
  • Chuhl Joo Lyu
    • 2
  • Dong Joon Kim
    • 3
  • Sung Chul Lee
    • 1
    Email author
  1. 1.Department of Ophthalmology, The Institute of Vision ResearchYonsei University College of MedicineSeoulKorea
  2. 2.Department of Pediatric Hematology and OncologyYonsei University College of MedicineSeoulKorea
  3. 3.Department of RadiologyYonsei University College of MedicineSeoulKorea

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