Critical appraisal of Gelfoam embolization technique in retinoblastoma treatment: call for caution and further investigation

We have closely examined the recent publication by Akkari et al regarding the use of Gelfoam pledgets for temporary occlusion of distal external carotid artery branches during intra-arterial chemotherapy (IAC) for retinoblastoma.1 The study introduces an innovative approach to address the challenge of backflow from the ophthalmic artery during IAC, and we appreciate the authors' efforts to explore new techniques in the treatment of retinoblastoma. However, we have several concerns regarding the methodology and the conclusions drawn from the study that we believe warrant further discussion.