Save the Eyes: A Review of Intra-Arterial Chemotherapy as a Therapeutic Approach for Retinoblastoma

Abstract Ophthalmic artery chemoinfusion (OAC) or intra-arterial chemotherapy has rapidly evolved as one of the important globe and vision-sparing treatment modalities in the management of advanced retinoblastoma (RB) in children. There has been significant evolution in the management of RB over the past few decades, with OAC coming to the forefront due to targeted delivery of the drug to the retina and a significant reduction in systemic adverse effects. However, case selection, dosing, and safe and optimal delivery of therapy are of utmost importance, and hence, meticulous attention to procedural details is extremely important for successful outcomes and for preventing complications. The main focus of this manuscript is to describe the history and evolution of the OAC, its role in the management of RB, and the technical nuances involved in OAC, including periprocedure patient care, anesthesia, angiographic considerations, special techniques in handling chemotherapeutic drugs, and radiation protection. The authors also provide their experience and technical tips for achieving better results, which may be implemented in clinical practice.