This is a retrospective review of all consecutive patients with primary (n=4) or secondary non-iatrogenic (n=16) aqueous seeding (AS) treated by intracameral chemotherapy (ICC) in Lausanne between 2011 and 2020 with a minimum follow-up of one year. Aqueous seeding control was initially achieved in all cases with a mean five injections of melphalan (n=13) or topotecan (n=7). Three eyes had isolated AS relapse at a mean interval eight months after the first ICC course, which was resolved with the second course of ICC Melphalan. Fifteen eyes with concomitant tumour sites were treated with other therapies. Three eyes had brachytherapy for sectorial involvement; three eyes had proton beam with annular involvement for interciliary process seed implantation. Eighty-five percent (17/20 eyes) achieved eye preservation at an event free mean follow-up of 45 months for aqueous disease and 40 months for any intraocular activity. Three had enucleation due to refractory non-aqueous disease. All patients were alive and no metastasis, with mean follow-up of 48 months after first ICC course. Intracameral chemotherapy toxicity included iris atrophy (five cases), cataracts (four cases), posterior synechiae (two cases), and iris heterochromia (one eye). No patient had irreversible vision loss and useful normal vision was achieved in 82% (14/17 cases). The paper concluded that ICC is a useful option against retinoblastoma in AS cases.
Ten-year experience with intracameral chemotherapy for aqueous seeding in retinoblastoma: long-term efficacy, safety and toxicity
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