Retinoblastoma is the most common paediatric intraocular malignancy. Recently, targeted treatment like intravitreal chemotherapy (ivc) and intra-arterial chemotherapy have become popular for managing advanced intraocular retinoblastoma [1]. Targeted treatment eliminates systemic side effects of treatment while allowing a remarkable increase in the chemotherapy dose delivered to the tumour. Hence, they are more effective and less toxic than the conventional systemic chemotherapy.

Most of the studies reported in the literature on ivc in retinoblastoma have studied treatment outcomes in cases of retinoblastoma with recalcitrant or recurrent vitreous seeds [2, 3]. In this study, we investigated whether ivc can cause retinal tumour regression in cases of retinoblastoma without seeds. This was a prospective, non-comparative interventional study (CTRI/2018/09/015860). Ethical clearance was obtained from the institutional ethics committee. This research adhered to the tenets of the Declaration of Helsinki. All eyes with retinoblastoma that showed disease progression/relapse in retina with standard intravenous chemotherapy and were planned for enucleation were evaluated for the study. Following clinical parameters were noted during examination under anaesthesia: anterior and posterior chamber findings, retinal tumour details including number, location and dimensions on ocular ultrasonography, presence and extent of retinal detachment and IOP as measured with Perkins applanation tonometer. All eyes with group E tumour as defined by International Classification of Retinoblastoma were excluded [4]. Eyes where there was total retinal detachment/size of tumour precluded the visualisation of all tumour edges were also excluded from the study. Photographic documentation was done using Retcam (Retcam III; Clarity Medical systems, Pleasanton, CA) in all cases. Written informed consent was taken from the parents. All eyes were administered intravitreal injection of melphalan (20 μg in 0.1 ml volume) using safety enhanced technique as described by Munier [5]. Tumour response evaluation was to be done during examination under anaesthesia after 2 weeks of injection. It was planned that in cases where reduction was noted in tumour size, the injection would be repeated till there was complete tumour regression (maximum of six injections) or it became feasible for focal treatment. In case no change or increase in tumour size was noted, the eye would be enucleated. Histopathological evaluation would be performed and the presence of any high-risk features/microscopic residual disease and any seeding of needle track will be looked for and noted.

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