Supplementary Material for: Choroidal Neovascularization Following Intra-Arterial Melphalan Chemotherapy for Retinoblastoma

Introduction

We present the unique case of a pediatric patient who underwent intra-arterial melphalan chemotherapy and subsequently developed choroidal neovascularization.

Case Presentation

A six-year-old male with a history of non-hereditary unilateral Group D retinoblastoma treated with intra-arterial melphalan, cryotherapy, and diode laser consolidative therapy presented to establish care. Initial evaluation revealed a regressed retinoblastoma lesion with chorioretinal scars and calcification scattered in the midperiphery. Notably, the macula was largely within normal limits without evidence of prior malignancy or scarring. However, seven months after establishing care, imaging was significant for intraretinal fluid, subretinal fluid, and subfoveal fibrosis of the treated eye, suggestive of choroidal neovascularization. The patient was managed with anti-VEGF therapy with resolution of subretinal fluid and improved visual acuity.

Conclusion

This case represents the first description and management of a patient developing choroidal neovascularization after receiving intra-arterial melphalan treatment for retinoblastoma. Careful monitoring of patients following intra-arterial melphalan chemotherapy treatment is critical due to the potential for vision loss, including choroidal neovascularization, which may be an under-reported complication.