OBJECTIVE

To study the treatment outcomes of ophthalmic artery chemosurgery (OAC) in children with unregressed retinoblastoma after 6 cycles of systemic chemotherapy.

STUDY DESIGN

Interventional prospective case series.

PLACE AND DURATION

Lahore General Hospital over one year from 1st October, 2017 to December, 2024. Patients were recruited from the outpatient Department of Ophthalmology and treated at Neuroangio Suite, Lahore General Hospital, Lahore.

MATERIALS AND METHODS

Children presenting with group D retinoblastoma and haring residual unregressed tumor  completion of 6 cycles of chemotherapy were included in the study. The tumor was classified according to the international classification of Retinoblastoma System (ICRB) on EUA treatment outcome of (OC) was evaluated in terms of signs of regression. The ophthalmic artery was cannulised through digital substraction angiography (DSA).

RESULTS

Our study included 45 children, 33 children had unilateral retinoblastoma while 12 children were one eyed due to enucleation of the other eye with group E tumor.

Signs of regression appeared after single OAC in 22 children, and after 2 OAC sessions in 12 children. Cannulisation of ophthalmic artery failed in 4 children who had narrow intra-arterial caliber.

A total of upto 11 treatment sessions were done, 30 with successful cannulisation of ophthalmic artery infundibulum. Melphalan was used alone in 5 sessions and melphalan + topotecan was given in the 4 sessions.

In 18 children, signs of regression appeared after single ophthalmic artery treatment, 10 children showed tumor regression after the second treatment session.

Severe vomiting within 24 hours post treatment was observed after 8 treatment sessions, mild to moderate reversible orbital swelling was observed after 7 treatment sessions. 3 children had severe prolonged orbital swelling which resolved 8 weeks after treatment with vision preservation.

Two children had chorio toxicity 12 hours post treatment and permanent loss of vision. All patients were followed for mean 10 + SD 1.2 months.

CONCLUSION

Ophthalmic artery chemosurgery is a useful tool for addressing residual intraocular retinoblastoma after completion of systemic chemotherapy in eyes with group D retinoblastoma at the time of initial presentation.

Umair Rashid is a medical professional at Lahore General Hospital and the Post Graduate Medical Institute, Pakistan, specializing in neuroradiology and ophthalmology. He focuses on advanced imaging techniques and eye‑brain disorders, contributing to clinical care and research.