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    Targeting refractory vitreous seeds in retinoblastoma

    Intravitreal topotecan impressive for both its efficacy, safety

    Hyderabad, India—Tri-weekly injection of topotecan is safe and effective as monotherapy for management of refractory vitreous seeds in retinoblastoma. Such findings are according to a retrospective study conducted by ocular oncologists at the National Retinoblastoma Foundation, Centre for Sight Superspecialty Eye Hospital, Hyderabad, India.

    The review included 17 eyes, all International Classification for Intraocular Retinoblastoma Group C or D, with persistent or recurrent vitreous seeds after standard intravenous chemotherapy ± local therapy. Tri-weekly topotecan 30 mcg/0.15 mL was administered until there was complete regression of the seeds and was followed by an additional injection for consolidation of probable microscopic residual seeds.

    Complete regression of vitreous seeds was achieved in all eyes after a mean of three injections, and 7 eyes (41%) required just two injections. No ocular or systemic complications were noted during a mean follow-up of 12 months.

    “To our knowledge, we are reporting the first case series of intravitreal topotecan as monotherapy in the management of refractory vitreous seeds in retinoblastoma, and our results indicate topotecan is a potent agent providing impressive control of refractory vitreous seeds,” said Raksha Rao, MD.

    “Our results with regard to vitreous seed regression and eye salvage are comparable to those previously reported for intravitreal melphalan,” Dr. Rao said. “However, the mean number of injections required was lower using topotecan than with melphalan, and according to previous reports and our own experience, intravitreal melphalan also causes few ocular side effects, whereas topotecan does not.”

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