Figure 7. Primary treatment choices based on the Murphree IIRC.

Treatment depends on the combined severity of each of the affected eyes (Eye 1 | Eye 2); the preferred option for each eye is depicted in the blue boxes. IIRC Group⁷⁸ A eyes can be treated with only laser or cryotherapy (focal therapy consolidation). Group⁷⁸ B and C eyes require several cycles of systemic intravenous chemotherapy (IVC) or intra-arterial chemotherapy (IAC) followed by focal therapy and intravitreal chemotherapy with melphalan and/or topotecan for residual or recurrent vitreous seeds. Isolated single tumours in Group⁷⁸ B or C eyes may occasionally be appropriate for primary radioactive plaque therapy. Group⁷⁸ D eyes require either IVC (with focal therapy consolidation) or IAC (with focal therapy consolidation). All eyes with features suggesting imminent extraocular extension (Group⁷⁸ E) should be removed so that accurate pathological examination can be performed to determine risk of metastasis requiring adjuvant chemotherapy. IIRC, International Intraocular Retinoblastoma Classification.⁷⁸