Introduction In intra-arterial chemotherapy for retinoblastoma, a backflow from unreachable external carotid artery branches in the ophthalmic artery can be challenging.

Aim of Study We describe a novel endovascular technique using Gelfoam® pledgets to occlude temporarily those distal external carotid artery branches to halt this competitive backflow.

Methods We queried our prospectively collected database of 327 consecutive patients treated for retinoblastoma by intra-arterial chemotherapy and identified those employing Gelfoam® pledgets. We describe this new technique with emphasis on feasibility and safety.

Results We treated 11 eyes with 14 infusions of intra-arterial chemotherapy using Gelfoam® pledgets to occlude the distal branches of the external carotid artery. We report no perioperative complications due to this occlusion technique. At the ophthalmologic follow-up one month after the injection of Gelfoam® pledgets, all cases showed tumor regression or stable disease. Two injections into the same eye as the rescue intra-arterial chemotherapy infusion resulted in a transient exudative retinal detachment, and one injection in a heavily pre-treated case was followed by iris neovascularization and retinal ischemia. None of the pledget injections led to irreversible vision-threatening intraocular complications.

Conclusion Intra-arterial chemotherapy in retinoblastoma using Gelfoam® to transiently occlude the distal branches of the external carotid artery and reverse the backflow into the ophthalmic artery seems feasible and safe. Larges series will help to confirm the effectiveness of this new technique.

Disclosure of Interest Nothing to disclose