Successful conservative treatment of massive choroidal relapse in 2 retinoblastoma patients monitored by ultrasound biomicroscopy and/or spectral domain optic coherence tomography

Ophthalmic Genet. 2018 Apr;39(2):242-246. doi: 10.1080/13816810.2017.1393826. Epub 2017 Nov 3.


Purpose: To report the occurrence and management of secondary choroidal infiltration in two retinoblastoma (rb) patients.

Methods: Fundus examination and imaging with spectral domain optical coherence tomography (SD-OCT), B-scan ultrasonography (B-scan), and ultrasound biomicroscopy (UBM).

Results: Case 1: A 19-month-old girl with multifocal unilateral group B rb pretreated with intravenous chemotherapy (IVC) was referred for further management. At 3.5 years of age, routine 3-Tesla magnetic resonance imaging (3T-MRI) revealed an asymptomatic pinealoblastoma that underwent resection and adjuvant intensive IVC. Concomitant ophthalmic follow-up revealed a recurrence 8.3 × 2.8 mm at the posterior pole nasally to the optic disc on B-scan, localized within the choroid on SD-OCT and 3T-MRI. With high dose IVC ongoing, total regression of the choroidal mass was confirmed on SD-OCT already after 3 weeks. At 6-month follow-up, choroidal and pineal tumors were in complete remission. Sadly, the child died of intravascular disseminated coagulation-like disease after the 5th IVC. Case 2: A heavily pretreated 20-month-old girl with bilateral rb was referred for persistent vitreous seeding in her remaining eye (OD). Three months after intravitreal chemotherapy and chemothermotherapy, a hemorrhagic mass was observed inferior to the primary tumor. Two weeks later, an underlying peripheral choroidal mass 16 × 6 mm was documented by UBM and confirmed by 3T-MRI. Complete resolution was achieved 3 weeks after combined intra-arterial chemotherapy (IAC) of melphalan-topotecan. No recurrence or metastasis was observed at 34-month follow-up.

Conclusion: Isolated massive choroidal invasion can be treated conservatively with IVC or IAC in selected cases. SD-OCT, UBM, and B-scan ultrasonography are instrumental in the detection and follow-up of choroidal lesions.

Keywords: Choroid; intra-arterial chemotherapy; intravenous chemotherapy; omography; retinoblastoma; spectral domain optic coherence; ultrasound biomicroscopy.

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Choroid Neoplasms / diagnostic imaging
  • Choroid Neoplasms / drug therapy*
  • Choroid Neoplasms / secondary
  • Conservative Treatment
  • Fatal Outcome
  • Female
  • Fluorescein Angiography
  • Humans
  • Infant
  • Infusions, Intra-Arterial
  • Magnetic Resonance Imaging
  • Melphalan / administration & dosage
  • Microscopy, Acoustic*
  • Neoplasm Recurrence, Local / diagnostic imaging
  • Neoplasm Recurrence, Local / drug therapy*
  • Neoplasm Recurrence, Local / pathology
  • Retinal Neoplasms / diagnostic imaging
  • Retinal Neoplasms / drug therapy*
  • Retinal Neoplasms / pathology
  • Retinoblastoma / diagnostic imaging
  • Retinoblastoma / drug therapy*
  • Retinoblastoma / secondary
  • Tomography, Optical Coherence*
  • Topotecan / administration & dosage


  • Topotecan
  • Melphalan