Received: 12 November 2021; Published on-line: 30 April 2022

Improving the ablastic capacity of intravitreal chemotherapy for retinoblastoma

N. F. Bobrova, T. A. Sorochynska, S. A. Tronina, O. Iu. Bratishko

SI "The Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine"; Odesa (Ukraine)

E-mail: filatov.detskoe7@gmail.com

TO CITE THIS ARTICLE: Bobrova NF, Sorochynska TA,   Tronina SA,   Bratishko OIu. Improving the ablastic capacity of intravitreal chemotherapy for retinoblastomaJ.ophthalmol.(Ukraine).2022;2:21-6.   http://doi.org/10.31288/oftalmolzh202222126

Background: Intravitreally (IV) administered cytostatics are believed to be a promising local chemotherapy for retinoblastoma (RB) because this approach enables the highest level of chemotherapeutic agent after its direct injection into the ocular cavity. Intravitreal administration is, however, invasive. Among the factors that prevent the wide use of intravitreal chemotherapy (IVitC) for RB is the risk of intraocular complications. In addition, exteriorization of the intraocular tumor may occur through the injection channel or extrabulbar tumor spread may occur.

Purpose: To develop a technique of IVitC for intraocular RB to improve its ablastic capacity through the prevention of extrabulbar tumor spread.

Material and Methods: An ablastic technique of IVitC was developed at the Department of Pediatric Eye Disorders, the Filatov institute, and used to perform 253 IV injections in 30 children (37 eyes) with T1 to T3 retinoblastoma.

Results: The advantages of the newly developed IVitC technique are as follows: achieving ocular hypotony without additional paracentesis; preventing reflux from the vitreous cavity by displacing the conjunctiva above the intravitreal entry point and forming an obliquely perpendicular injection channel; treating the site of scleral puncture with cotton swab tamponade and applying antibiotic solution subconjunctivally;  preventing an infection of the vitreous and scleral thinning in repeat IVitC. There were no perioperative or postoperative complications. In addition, there were no signs of extrabulbar tumor spread during follow-up after IVitC. The number of IV injections per eye ranged from 1 to 13.

Conclusion: An improved ablastic capacity of the developed IVitC technique was achieved by reducing (a) reflux from the vitreous through a number of above manipulations and (b) traumatic effect of intervention, as well as preventing complications, which enabled the minimal invasiveness and safety of the technique.

Keywords: retinoblastoma, chemotherapy,  intravitreal injection

Conflict of Interest Statement. The authors declare no conflict of interest.

Funding Support. There are no external sources of funding.



1.Bobrova NF, Naumenko VO, Sorochynska TA, Tronina SA, Dembovetska GM. [Diagnostic assessment and treatment of children with retinoblastoma, a malignant retinal tumor: a protocol]. Oftalmol Zh. 2012;1:80-4. Russian.


2.Bobrova NF, Sorochynska TA. [Combined (intravitreal and intravenous) polychemotherapy in organ-preserving treatment for retinoblastoma. Oftalmol Zh. 2011;2:38-44. Ukrainian.


3.Ericson LA, Rosengren BH. Present therapeutic resources in retinoblastoma. Acta Ophthalmol. Acta Ophthalmol (Copenh). 1961;39:569-76.

Crossref  PubMed 

4.Frederici TJ. Intravitreal injections:  AAO's Focal Points. Clinical Modules for Ophthalmologists. 2009;27(8, module 2):1–12.

5.Ghassemi F, Khodabande A. Risk definition and management strategies in retinoblastoma: current perspectives. Clin Ophthalmol. 2015 Jun 8;9:985-94.

Crossref  PubMed

6.Seregard S, Kock B, Trampe E,Seregard S. Intravitreal chemotherapy for recurrent retinoblastoma in an only eye. Br J Ophthalmol. 1995 Feb;79(2):194-5.

Crossref  PubMed

7.Shields CL, Manjandavida FP, Arepalli S, et al. Intravitreal melphalan for persistent or recurrent retinoblastoma vitreous seeds: preliminary results. JAMA Ophthalmol. 2014;132(3):319-325.

Crossref  PubMed

8.Smith SJ, Smith BD. Evaluating the risk of extraocular tumour spread following intravitreal injection therapy for retinoblastoma: a systematic review. Br J Ophthalmol. 2013 Oct;97(10):1231-6.

Crossref  PubMed

9.Suzuki S, Aihara Y, Fujiwara M, Sano S, Kaneko A. Intravitreal injection of melphalan for intraocular retinoblastoma. Jpn J Ophthalmol. 2015 May;59(3):164-72.

Crossref  PubMed

10.Jager RD, Aiello LP, Patel SC, et al. Risks of intravitreous injection: a comprehensive review. Retina. 2004 Oct;24(5):676-98.

Crossref  PubMed

11.Kaneko A, Suzuki S. Eye-Preservation Treatment of Retinoblastoma with Vitreous Seeding. Jpn J Clin Oncol. 2003 Dec;33(12):601-7.

Crossref  PubMed 

12.Munier FL, Gaillard M-C, Balmer A, Beck-Popovic M. Intravitreal chemotherapy for vitreous seeding in retinoblastoma: Recent advances and perspectives. Saudi J Ophthalmol. 2013 Jul;27(3):147-50.

Crossref  PubMed

13.Munier FL, Soliman S, Moulin A, et al. Profiling safety of intravitreal injections for retinoblastoma using an anti-reflux procedure and sterilization of the needle track. Br J Ophthalmol.  2012;96(8):1084–1087. 2012 Aug;96(8):1084-7.

Crossref  PubMed

14.Bobrova NF, editor. [Retinoblastoma]. Odesa: Izdatelskii tsentr; 2020. Russian.

15.Bobrova NF, Sorochynska TA.  [Method of combination treatment for retinoblastoma]. Patent of Ukraine 55690 issued on December 12, 2010. Ukrainian.

16.Bobrova NF, Naumenko VO, Sorochynska TA, Komarnytska TI.  [Method of treatment for residual and recurrent retinoblastomas located posterior to the equator]. Patent of Ukraine UA 133456 issued on March 10, 2018. Bulletin No.7/2018. Ukrainian.

17.Bobrova NF, Sorochynska TA, Bratishko OIu. [Method of intravitreal chemotherapy for retinoblastoma]. Patent of Ukraine UA 144595 issued on October 12, 2020. Bulletin No.19/2020. Ukrainian.