A 6-month-old infant presents with leukocoria and a large white reflex in the left eye. B-scan shows calcification. CT reveals intraocular calcification. The PREFERRED initial management of unilateral retinoblastoma confined to the globe (IIRC group D) is:
- A Intra-arterial chemotherapy (ophthalmic artery cannulation with melphalan) ✓
- B External beam radiotherapy
- C Primary enucleation
- D Intravenous chemotherapy (vincristine, etoposide, carboplatin) followed by focal consolidation
Explanation
For group D unilateral retinoblastoma (large diffuse tumour, extensive subretinal/vitreous seeds), intra-arterial chemotherapy (IAC) with melphalan delivered selectively to the ophthalmic artery provides high local drug concentrations with less systemic toxicity. IAC has largely replaced IV chemotherapy as first-line for advanced unilateral retinoblastoma in centres with expertise, achieving globe salvage in up to 70% of group D eyes. Primary enucleation remains appropriate if IAC is unavailable or fails. External beam radiotherapy is now avoided due to risk of secondary tumours.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.