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Intravitreal chemotherapy-induced cataract in retinoblastoma: challenges and outcome
  1. Vivekanand Warkad1 and
  2. Devjyoti Tripathy2
  1. 1Paediatric Ophthalmology, Strabismus and Neuro-ophthalmology, Child Sight Institute, LV Prasad Eye Institute, MTC Campus, Bhubaneswar, Odisha, India
  2. 2Ophthalmic Plastic Surgery, Orbit and Ocular Oncology, Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, MTC Campus, Bhubaneswar, Odisha, India
  1. Correspondence to Dr Devjyoti Tripathy; drdtripathy{at}gmail.com

Abstract

A toddler with bilateral retinoblastoma (Rb) received intravenous chemotherapy for advanced tumours in both eyes. The right eye required enucleation due to a poor response, but the left eye was salvaged by additional treatment with intravitreal chemotherapy for tumour vitreous seeds. Though the vitreous seeds regressed, a gradually progressive cataract developed likely due to drug toxicity. On ensuring continued regression of tumour within the eye, cataract extraction was performed. Surgery was uneventful and the child recovered good functional vision in the left eye. Salvaging the eyeball followed by vision restoration through cataract surgery in the only remaining eye of the child necessitated a multidisciplinary approach involving the ocular oncologist, the paediatric medical oncologist and the paediatric ophthalmologist. Ensuring tumour quiescence within the eye clinically before cataract surgery was the most crucial element of management. Additionally, close monitoring of the progress of the cataract to decide when to intervene was also necessary to keep the risk of amblyopia at bay. The patient recovered good functional vision in the left eye after the surgery and remained free of any tumour recurrence or systemic metastasis at 10 months of follow-up.

  • Eye
  • Paediatric oncology
  • Retina
  • Paediatric Surgery

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Footnotes

  • Twitter @devtripathyNU

  • Contributors DT did the literature search, drafting, writing and revision of the manuscript. VW did the writing and revision of the manuscript. Patient was under the care of both DT and VW.

  • Funding This study was funded by the Hyderabad Eye Research Foundation.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.