Renu P Rajan, Muthukrishnan V, Usha Kim, Naresh B Kannan, Kim Ramasamy, Arpit Sharma
Early, tailored vitrectomy may help preserve vision in severe endophthalmitis after IVT chemotherapy for retinoblastoma when strict oncologic precautions are maintained, with long-term follow-up required to monitor for tumor recurrence or extraocular spread.
PURPOSE: To describe the management and clinical outcome of severe infectious endophthalmitis after intravitreal (IVT) topotecan injection for retinoblastoma in an eye with potential vision.
METHODS: A single case was reviewed.
RESULTS: An 8-month-old child with bilateral retinoblastoma receiving systemic chemotherapy developed acute endophthalmitis in the only eye with potential vision 3 days after the sixth IVT topotecan injection. Urgent 23-gauge pars plana vitrectomy was performed to clear dense vitritis and maintain oncologic control using a closed-system approach, melphalan irrigation (5 µg/mL), IVT topotecan, port-site cryotherapy, and silicone oil tamponade. The patient also received IVT vancomycin, ceftazidime, and voriconazole. Vitreous culture identified Haemophilus influenzae. The infection resolved, the tumor continued to regress, and no extraocular tumor spread was observed during 24 months of follow-up.
CONCLUSIONS: Early, tailored vitrectomy may help preserve vision in severe endophthalmitis after IVT chemotherapy for retinoblastoma when strict oncologic precautions are maintained, with long-term follow-up required to monitor for tumor recurrence or extraocular spread.