Severe visual loss and ocular complications after intra-arterial chemotherapy for retinoblastoma

Retinoblastoma (RB) treatment aims to ensure survival, globe preservation and visual function. Intra-arterial chemotherapy (IAC) has improved globe salvage, but there remains limited information on visual outcomes following this treatment. This study evaluates final visual acuity (VA) in patients with RB treated with IAC, identifying factors contributing to vision loss.

A retrospective review was conducted at La Paz University Hospital in Madrid, including 71 eyes from 60 patients treated with IAC from 2016 to 2025. Data collected included the International Classification of Retinoblastoma and foveal involvement at diagnosis. VA was assessed using the Snellen chart and converted to the logarithm of the minimum angle of resolution (logMAR). The primary outcome was VA. The secondary outcome was the incidence of choroidal occlusive vasculopathy (COV).

Of the 71 eyes, 24 belonged to patients too immature for VA assessment, and 20 were enucleated due to disease progression. Among the 27 eyes with measurable VA, 7 had a healthy fovea at diagnosis. 23 (85.2%) had a VA≥1.0 logMAR, including 10 (37%) with no light perception. Only four eyes (14.8%) achieved a VA<1.0 logMAR, all with a healthy fovea at diagnosis. Linear regression showed significant association between foveal involvement at diagnosis and reduced final VA. 16 of 71 eyes (22.5%) developed COV, with statistically significant correlation with the number of IAC cycles.

IAC is effective for tumour control and eye preservation but often yields poor visual outcomes in advanced RB due to pre-existing damage and complications like COV. These findings emphasise the importance of counselling families regarding the visual limitations of IAC treatment.