(FIGURE 1) Technique of intravitreal topotecan chemotherapy. A. Transconjunctival pars plana intravitreal injection of topotecan at a dose of 30 μg in 0.15 ml with a 30-gauge needle. B. Needle withdrawal through the first ice ball of cryotherapy. C. Triple freeze-thaw cryotherapy at the injection site. D. Forceps-assisted jiggling of the eyeball following the injection for an even dispersion of topotecan.
(Images courtesy of Santosh G. Honavar, MD)
(FIGURE 2) Vitreous seed control with intravitreal topotecan monotherapy. A.. Recurrent diffuse vitreous seeds in the only eye of a patient with bilateral retinoblastoma. B. Thirteen months after two doses of intravitreal topotecan injections with complete control of vitreous seeds. C. Massive recurrence of diffuse vitreous seeds in the only eye of a patient after six cycles of chemotherapy and three periocular carboplatin injections.
D. Eighteen months after two doses of intravitreal topotecan injections with total regression of vitreous seeds. E. Recurrent focal vitreous seeds in unilateral retinoblastoma after six cycles of chemotherapy. F. At 12 months follow-up after two doses of intravitreal topotecan.