Intravitreal melphalan for persistent retinoblastoma vitreous seeds

A 7-month-old male presented with bilateral retinoblastoma, initially group E OD and group C OS (International Intraocular Retinoblastoma Classification). The patient underwent enucleation with adjuvant chemotherapy and radiotherapy on the right eye for extraocular retinoblastoma. The main tumors on the left eye regressed with combined neoadjuvant chemotherapy with focal therapy, but had persistent sphere vitreous seeds overlying the tumor at the superotemporal mid-periphery and at the inferior periphery. Intravitreal injection of melphalan was performed. Vitreous seeds were clinically undetectable after 2 cycles of injection. Six months from the 2nd intravitreal injection of melphalan, there was no evidence of new tumors nor vitreous seeds in the left eye. No documented complications of intravitreal melphalan injection were experienced. This is the first documented successful treatment of vitreous seeds with intravitreal melphalan at the Ocular Oncology/Retinoblastoma Unit of the University of the Philippines, Philippine General Hospital.