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Retinoblastoma if left untreated is almost invariably fatal, but prognosis improved markedly when surgeons in the late 19th century learned to enucleate eyes harbouring early retinoblastoma. Without compromising prognosis, management of retinoblastoma has since focused on the preservation of vision, evolving from surgical removal of the eye to radiotherapy and recently to systemic chemotherapy. Systemic chemotherapy (using the intravenous route) with or without focal consolidation therapy has not only been highly successful in retaining many eyes with visual function but has also avoided radiation-induced side effects. However, systemic chemotherapy by default exposes the entire body to significant doses of highly toxic drugs in order that only a minute fraction (<1% by weight) of the body can be treated. The potential late side effects of this massive overtreatment are still largely unknown.
This insight has driven the advent of periocular administration1 and more recently, selective intra-arterial administration of chemotherapeutic drugs.2 Superselective cannulation of the ophthalmic artery requires a trained interventionist and given that reports of significant side effects are now …
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.