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Orbital Retinoblastoma Treated with Intra-arterial Chemotherapy

      A 5-year-old boy was referred with local orbital extension of unilateral retinoblastoma (Fig A) and measurable plasma cell-free RB1 DNA (Fig B, magnetic resonance imaging [MRI]). Two years prior he had received 2 courses of systemic chemotherapy with Carboplatin, Vincristine and Etoposide but additional treatment was halted because of a war in his country. Thirteen months later, after 3 sessions of ophthalmic artery chemosurgery with Melphalan, Carboplatin, and Topotecan at our institution, there was complete resolution of the tumor (Fig C) and disappearance of cfDNA (Fig D, MRI). Orbital retinoblastoma in the United States is usually a manifestation of widespread metastatic disease, but local extension through the sclera into the orbit may be controlled with focal intra-arterial chemotherapy to the orbit alone (Magnified version of Fig A-D is available online at www.aaojournal.org).