Classification and management of seeds in retinoblastoma. Ellsworth Lecture Ghent August 24th 2013

Ophthalmic Genet. 2014 Dec;35(4):193-207. doi: 10.3109/13816810.2014.973045. Epub 2014 Oct 16.


Retinoblastoma has the unique capacity to accelerate its own intra-ocular propagation by adopting semi-solid or even liquid growth properties through seeding. Until recently, the presence of any degree of seeding was mostly incompatible with successful conservative management, due to the multiresistant nature of the seeds. Surprisingly, this well-recognized retinoblastoma behavior has not undergone any detailed description of seeding patterns and anatomic sites. In this paper, we describe the phenotypic variability of seeds across the four possible intraocular seeding compartments and classify them into three fundamental types: namely dust, spheres, and clouds. We also provide an overview of the different therapeutic strategies developed for seeding, with special attention to intravitreal chemotherapy as the treatment of choice for vitreous and retro-hyaloid seeding. Finally, we propose criteria to enable assessment of the response to treatment by reporting seed regression patterns, as well as a clinical grading system for the retinal toxicity observed following intravitreal melphalan.

Keywords: Classification; intravitreal chemotherapy; retinoblastoma; seeding.

Publication types

  • Lecture

MeSH terms

  • Antineoplastic Agents / therapeutic use
  • Humans
  • Neoplasm Seeding*
  • Retinal Neoplasms / classification*
  • Retinal Neoplasms / drug therapy
  • Retinal Neoplasms / pathology
  • Retinoblastoma / classification*
  • Retinoblastoma / drug therapy
  • Retinoblastoma / pathology
  • Vitreous Body / pathology*


  • Antineoplastic Agents