In retinoblastoma management, the D-E-E rule (IIRC classification groups D and E) indicates advanced intraocular disease. Which treatment modality is now preferred for group D unilateral retinoblastoma to avoid enucleation?

• A External beam radiotherapy (EBRT) to the affected orbit
• B Intravitreous melphalan injection for vitreous seeds plus systemic chemotherapy
• C Thermotherapy alone using infrared diode laser
• D Intra-arterial chemotherapy (ophthalmic artery chemosurgery) with melphalan via superselective catheterization ✓

Explanation

Intra-arterial chemotherapy (IAC/ophthalmic artery chemosurgery — OAC) via superselective catheterization of the ophthalmic artery with melphalan (and sometimes carboplatin or topotecan) has revolutionized management of advanced intraocular retinoblastoma (groups C, D), achieving eye salvage rates of 70–80% for group D. EBRT is now largely abandoned for intraocular retinoblastoma due to risk of second malignancies (especially in hereditary cases with germline RB1 mutation) and facial deformity. Intravitreous melphalan is used additionally for vitreous seeds.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.