Choroidal Neovascularization following Intra-Arterial Melphalan Chemotherapy for Retinoblastoma

We present the unique case of a pediatric patient who underwent intra-arterial melphalan chemotherapy and subsequently developed choroidal neovascularization.

A 6-year-old male with a history of nonhereditary unilateral group D retinoblastoma treated with intra-arterial melphalan, cryotherapy, and diode laser consolidative therapy presented to establish care. Initial evaluation revealed a regressed retinoblastoma lesion with chorioretinal scars and calcification scattered in the midperiphery. Notably, the macula was largely within normal limits without evidence of prior malignancy or scarring. However, 7 months after establishing care, imaging was significant for intraretinal fluid, subretinal fluid, and subfoveal fibrosis of the treated eye, suggestive of choroidal neovascularization. The patient was managed with anti-VEGF therapy with resolution of subretinal fluid and improved visual acuity.

This case represents the first description and management of a patient developing choroidal neovascularization after receiving intra-arterial melphalan treatment for retinoblastoma. Careful monitoring of patients following intra-arterial melphalan chemotherapy treatment is critical due to the potential for vision loss, including choroidal neovascularization, which may be an under-reported complication.