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Tethered Vitreous Seeds Following Intravitreal Melphalan for Retinoblastoma

Jasmine H. Francis, MD1; Brian P. Marr, MD1,2; Scott E. Brodie, MD, PhD1,3; Yves Pierre Gobin, MD4,5; David H. Abramson, MD1,2
[+] Author Affiliations
1Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
2Department of Ophthalmology, Weill Cornell Medical College, New York, New York
3Department of Ophthalmology, Mount Sinai School of Medicine, New York, New York
4Service of Interventional Neuroradiology, Department of Neurosurgery, Weill Cornell Medical College of New York Presbyterian Hospital, New York, New York
5Service of Interventional Neuroradiology, Department of Neurology and Radiology, Weill Cornell Medical College of New York Presbyterian Hospital, New York, New York
JAMA Ophthalmol. 2014;132(8):1024-1025. doi:10.1001/jamaophthalmol.2014.436.
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Placing a needle into an eye with retinoblastoma, whether for diagnostic or therapeutic purposes, has historically been avoided owing to concerns of extraocular spread along the needle track.1,2 In the past 3 years, intravitreal injections of melphalan have been used worldwide, with excellent results for vitreous seeding and an exceedingly low risk of extraocular extension.3,4 The treatment course involves repetitive puncture sites with approximately 6 to 8 weekly injections and often a concomitant paracentesis by some groups.3,5 Techniques have been adopted to enhance safety, including reduction of intraocular pressure and cryotherapy of the injection site.5 Despite low documented risk of extraocular extension,4 we describe 2 instances in which active vitreous seeds were drawn toward the ocular surface. While disease did not exit the eye, it did tether to the injection site and eventually regressed with a continuation of treatment.

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Fundus Photograph of Case 1

A, Vitreous seed tethered to the injection site following 2 intravitreal melphalan injections B, One year later, following cryotherapy and 3 additional injections, the vitreous seed has regressed to a collection of pigment.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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RetCam Imaging of Case 1

RetCam imaging demonstrates tethering of the seed at the injection site.

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