Intra-arterial chemotherapy for retinoblastoma: report No. 2, treatment complications. Arch Ophthalmol 2011 Nov;129(11):1407-15
Date
06/15/2011Pubmed ID
21670326DOI
10.1001/archophthalmol.2011.151Scopus ID
2-s2.0-81355133314 (requires institutional sign-in at Scopus site) 148 CitationsAbstract
OBJECTIVE: To describe treatment complications following intra-arterial chemotherapy (IAC) for retinoblastoma.
METHODS: A retrospective interventional series of ophthalmic artery cannulation for IAC injection (3 planned sessions at 1-month intervals) was undertaken. Thirty-eight catheterizations of 17 eyes of 17 patients were performed from September 2008 to September 2010. Fluoroscopy of the ophthalmic artery was performed before and immediately after treatment. Heparin was given during the procedure and aspirin (40 mg) was given orally for 1 week. The treatment complications were determined.
RESULTS: Only 17 of 190 children were selected for treatment with IAC during this period. Following successful ophthalmic artery cannulation in 16 cases, there was no evidence of metastasis, stroke, brain injury, or persistent systemic toxic effects. Fluoroscopy demonstrated patent ophthalmic artery immediately before and after IAC injection in each case. Following therapy, orbital and adnexal findings at 1 month included eyelid edema (n = 13), blepharoptosis (n = 10), cilia loss (n = 1), and orbital congestion with temporary dysmotility (n = 12). These findings resolved within 6 months in all cases. Following therapy, vascular findings included ophthalmic artery stenosis (permanent in 3 cases, temporary in 1 case), confirmed on fluoroscopy in 3 cases. Concomitant central or branch retinal artery occlusion was noted (permanent in 2 cases, temporary in 1 case). Subtle retinal pigment epithelial mottling in 9 cases that slowly evolved to later-onset underlying choroidal atrophy in 5 cases was noted.
CONCLUSIONS: Treatment with IAC for retinoblastoma can lead to mild and severe short-term ocular complications, including eyelid edema as well as potentially blinding vascular obstruction. This procedure should be used with caution.
Author List
Shields CL, Bianciotto CG, Jabbour P, Griffin GC, Ramasubramanian A, Rosenwasser R, Shields JAAuthor
Aparna Ramasubramanian MD Associate Professor in the Ophthalmology and Visual Sciences department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Antineoplastic Agents, AlkylatingBlepharoptosis
Catheterization
Chemotherapy, Cancer, Regional Perfusion
Child
Child, Preschool
Edema
Eyelid Diseases
Female
Fluorescein Angiography
Fluoroscopy
Humans
Infant
Injections, Intra-Arterial
Male
Melphalan
Ocular Motility Disorders
Ophthalmic Artery
Retinal Neoplasms
Retinoblastoma
Retrospective Studies
