What we did next:
C. Intravitreal chemotherapy + laser
Intravitreal chemotherapy (IVitC) offers a localized treatment approach for recurrent intraocular tumors that is refractory to OAC. Traditionally, IVitC has been used to treat intravitreal seeds1 however recent use of IVitC for indications other than vitreous seeds has shown to be successful.2 IVitC avoids the time and cost associated with OAC.
This patient was successfully treated with three rounds of IVitC + laser to the right eye:
round 1: 30 µg intravitreal Topotecan + laser
round 2: 30 µg intravitreal Topotecan + 25 µg intravitreal Melphalan
round 3: 25 µg intravitreal Melphalan + laser.
The remaining tumor regressed (see photo below) and thus far this patient has been followed for 18.5 months without recurrence in either eye. Most recent ERG readings were 48µV OD and 144µV OS.