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Background: The treatment modalities for managing retinoblastoma have evolved in the past decade. While globe-salvage still relies heavily on intravenous chemotherapy, tumors in advanced stages D and E that failed chemotherapy are now referred for intra-arterial chemotherapy (IAC) to avoid enucleation.Aim of the Study: To evaluate the effectiveness and com-plications of intra-arterial chemotherapy (IAC) for treating advanced refractory group D and E retinoblastoma (RB).Material and Methods: 30 intro-ocular advanced refractory retinoblastoma of 26 consecutive patients who received IAC were included in the study during the period between Novem-ber 2013 and January 2017. These patients failed to respond adequately to a standard systemic chemotherapy (i.e., carbo-platin, vincristine, and etoposide) with or without local therapy. Clinical outcomes and complications of these patients were reviewed.Results: All our patients received IAC with injection of melphalan. The mean follow-up period was 14.2 months after final IAC (ranged from 6 to 20 months). The rate of overall globe salvage was 95% in Group D and 30% in Group E of this study. Short-term ocular adverse events included eyelid edema (n=15, 50%), bulbar conjunctiva congestion (n=7, 23.3%), mild ptosis (n=5, 16.7%) and long-term complications included ophthalmic artery spasm with reperfusion (n=2, 6.7%) retinal atrophy (n=1, 3.3%). Fever was observed after IAC in 10 patients and transient vomiting was observed in 16 patients.Conclusion: IAC can be an evolving optional treatment to save Group D RB that failed in systemic chemotherapy and were destined for enucleation. However, it should be cautioned for Group E. Both the ocular and systemic toxicities of IAC were within tolerance.

The Role of Intra-Arterial Chemotherapy in the Manegment of Advanced Retinoblastoma; Group D & E