OAC was introduced more than 10 years ago and has been shown to be effective in treating retinoblastoma.5 The majority of recurrences happen within the first year following the completion of OAC and eyes that receive drug via non-ophthalmic artery routes are more likely to recur.5 In this case, we inherited this patient after completing OAC and therefore had limited knowledge on the route of administration of OAC. Given his second attempt at OAC was unsuccessful at the prior hospital, we cannot exclude the scenario in which there may have been damage to the pathway leading to the ophthalmic artery, posing risk to the patient if we attempted OAC a third time.

Enucleation certainly eliminates the tumor however, there are other options that could work in this scenario and spare the eye. It is true that the recurrence was close to the optic nerve, but MRI imaging confirmed there was no invasion of the optic nerve, allowing more flexibility in treatment options. Additionally, this option may be rejected by a family who is highly motivated to salvage the eye. This treatment option should not be completely taken off the table, but at the very least should be reserved for a “last resort” intervention particularly when other effective and less-invasive treatment options are available.