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Background: Retinoblastoma management has seen a paradigm shift with intra-arterial chemotherapy (IAC). Using IAC as primary management in this paediatric cancer is becoming more widespread in developing countries such as Malaysia. Considerable evidence shows that IAC has a more beneficial globe salvage rate than
intravenous chemotherapy (IVC).

Case presentation: This case report describes a successful globe salvage in Group D retinoblastoma with primary IAC and the complications experienced with this mode of treatment, especially the vascular events seen which could possibly contribute to persistent poor vision despite a completely regressed tumour.

Conclusion: Despite the remarkable tumour regression and globe preservation, the patient’s vision did not improve in the treated eye. We wish to explore the possibilities resulting in those complications and methods to reduce them in the future.