scholarly journals Precision Intravitreal Chemotherapy for Localized Vitreous Seeding of Retinoblastoma

2018 ◽  
Vol 5 (4) ◽  
pp. 284-289 ◽  
Author(s):  
Michael D. Yu ◽  
Lauren A. Dalvin ◽  
R. Joel Welch ◽  
Carol L. Shields
Keyword(s):  
Retinal Pigment ◽  
Tumor Control ◽  
Injection Technique ◽  
Complete Control ◽  
Intravitreal Chemotherapy ◽  
Pars Plana ◽  
Direct Delivery ◽  
Vitreous Seeds ◽  
Vitreous Seeding

Purpose: To describe and evaluate the effectivity of a novel precision intravitreal injection technique for select cases of localized vitreous seeding in retinoblastoma. Methods: Patients with localized vitreous seeds from retinoblastoma received intravitreal chemotherapy via a precision injection technique (P-IVitC) intended to optimize local delivery of melphalan to target seeds. The needle was inserted trans-pars plana and chemotherapy deposited within 3 mm of the target seed(s) under indirect ophthalmoscopic guidance. Without subsequent globe manipulation, the head was then positioned to promote gravity-dependent settling of chemotherapy. Results: There were 8 eyes of 8 patients treated with P-IVitC for active vitreous seeds following adequate solid tumor control with intravenous chemotherapy (n = 3, 38%) or intra-arterial chemotherapy (n = 5, 63%). Viable vitreous seeds were primarily solitary spheres (n = 6, 75%) and measured an average of 2.7 mm in diameter. Vitreous seed resolution (n = 8, 100%) was noted after a mean of 2.6 injections (median 2; range 1–3) of 20 μg melphalan. There was no recurrence at a mean follow-up of 10.0 months. Only 1 eye had an associated complication (focal retinal pigment epithelial mottling, n = 1, 13%). Conclusions: With direct delivery of chemotherapy to within 3–4 mm of vitreous seed activity, P-IVitC provided complete control of localized vitreous seeds with minimal toxicity.

Intravitreal Chemotherapy in the Management of Vitreous Disease in Retinoblastoma

2017 ◽  
Vol 27 (4) ◽  
pp. 423-427 ◽  
Author(s):  
Hayyam Kiratli ◽  
İrem Koç ◽  
Ali Varan ◽  
Canan Akyüz
Keyword(s):  
Side Effects ◽  
Retinal Pigment Epithelial ◽  
Retinal Pigment ◽  
Vitreous Hemorrhage ◽  
Intravitreal Chemotherapy ◽  
Pars Plana ◽  
Vitreous Seeds ◽  
Number Of Injections ◽  
Vitreous Seeding

Purpose To evaluate the therapeutic outcome of intravitreal melphalan injection in the management of vitreous disease in patients with retinoblastoma. We particularly aimed to assess whether higher melphalan dose with lower number of injections was more effective and associated with fewer side effects. Methods This retrospective, interventional, noncomparative, and nonrandomized study included 39 eyes of 37 patients. Vitreous seeds were classified as dust, sphere, and cloud types. Intravitreal injections were performed through pars plana free of any visible tumor using 30-G needle. Response of the seeds (disappearance, conversion into inactive debris, or progression) and enucleation rate were determined as outcome measures. Results All patients previously received systemic or intra-arterial chemotherapy. Vitreous seeding was primary in 54% of eyes and secondary in 46% of eyes. Vitreous seeds were classified as dust in 9 (23.1%) eyes, sphere in 24 (61.5%) eyes, and cloud in 6 (15.4%) eyes. Melphalan dose varied between 20 and 40 µg and 20 (51.3%) eyes received >30 µg. The total number of injections was 70 (range 1-5, mean 1.8 per eye). Various types of regression were obtained in 27 (69.2%) eyes. Sphere-type seeds were the most responsive to melphalan. Nonresponse and disease progression were noted in 12 (30.8%) eyes. After a mean follow-up of 11.8 months, 17 (44%) eyes were enucleated. Vitreous hemorrhage (18%) and retinal pigment epithelial alterations (8%) were the most common side effects. Conclusions Intravitreal melphalan at 30-40 µg in 1 or 2 injections proved effective in 69.2% of eyes with vitreous disease.

scholarly journals Effectiveness of Intravitreal Chemotherapy-Assisted Endoresection in Monocular Patients with Group D Retinoblastoma

2020 ◽  
Author(s):  
Xiling Yu ◽  
Xueke Li ◽  
Yue Xing ◽  
Siduo Lu ◽  
Silvia Tanumiharjo ◽  
...  
Keyword(s):  
Pars Plana Vitrectomy ◽  
Case Series ◽  
Tumor Control ◽  
Repeated Treatment ◽  
Promising Alternative ◽  
Tumor Seeding ◽  
Intravitreal Chemotherapy ◽  
Pars Plana ◽  
Group D

Abstract Background: To determine the efficacy and complications of intravitreal chemotherapy-assisted endoresection for refractory group D retinoblastoma in monocular patients.Methods: In this retrospective case series, intravitreal chemotherapy-assisted endoresection by pars plana vitrectomy was performed in 11 eyes with refractory ICRB group D retinoblastoma unresponsive to standard therapies in monocular patients.Results: Across a mean follow-up period of 42.7 months, globe salvage was attained in all 11 eyes (100%). There was no case of extra-ocular tumor seeding or remote metastasis. In 9 eyes (81.8%), tumor control was achieved with one-time pars plana vitrectomy, whereas in 2 cases (18.2%), repeated treatment such as laser, intravitreal chemotherapy or second pars plana vitrectomy were needed. Retinal reattachment was achieved in all 4 eyes (100%) with previous retinal detachment. 4 eyes (36.4%) required subsequent cataract surgery due to secondary cataract. 10 eyes (90.9%) had improvement in best-corrected visual acuity at the last follow-up.Conclusion: Intravitreal chemotherapy-assisted endoresection appears to be a safe and effective globe-salvaging method for refractory group D retinoblastoma. It is a promising alternative to enucleation and a supplementary therapeutic strategy for those unresponsive to standard therapies, especially for the monocular retinoblastoma patients.

Intra-Arterial Chemotherapy for Retinoblastoma: A Single-Center Experience

2015 ◽  
Vol 234 (4) ◽  
pp. 227-232 ◽  
Author(s):  
Canan Akyüz ◽  
Hayyam Kıratlı ◽  
Hilal Şen ◽  
Burça Aydın ◽  
Berçin Tarlan ◽  
...  
Keyword(s):  
Optic Atrophy ◽  
Systemic Chemotherapy ◽  
Retinal Pigment ◽  
Local Therapy ◽  
Tumor Control ◽  
Ocular Motility ◽  
Newly Diagnosed ◽  
Upper Eyelid ◽  
Vitreous Seeding

Background: Studies conducted in recent years have reported promising results regarding the treatment of retinoblastoma with the intra-arterial use of melphalan. In the present study, we intended to report the results of intra-arterial chemotherapy with melphalan (IACT) in the treatment of newly diagnosed or relapsed-refractory retinoblastoma patients at the Department of Pediatric Oncology of Hacettepe University, Ankara, Turkey. Materials and Methods: This was a retrospective study of patients with intraocular retinoblastoma who were treated with IACT from December 2011 to May 2014. A total of 56 eyes of 46 consecutive patients (30 males and 16 females) were included in the study. Forty-four eyes received systemic chemotherapy upon diagnosis (systemic chemotherapy group, SCG), and 12 eyes were those of newly diagnosed patients (primary intra-arterial melphalan group, PIAG). The choice of the IACT dose was based on age. Tumor control and globe salvage with IACT were analyzed. Complete blood counts were examined 7 days after the IACT for systemic toxicity. Ocular toxicities such as proptosis, eyelid edema, ocular motility, and retinal and optic atrophy were assessed by an ocular oncologist with regular ophthalmologic examinations. Results: Enucleation was avoided overall in 66% (37/56) of the eyes, including 75% (9/12) in the PIAG and 64% (28/44) in the SCG patients. The 1-year enucleation-free survival rate was 56.7% at a median follow-up time of 11.9 months (range 0.27-27.6). IACT was administered in a total of 124 cycles (ranging from 1 to 7 cycles, mean 2.3). The responses were as follows: regression of the retinal tumor in 27 eyes and improvements in vitreous seeding in 5 of 15 eyes. The further treatment requirements after IACT were as follows: enucleation in 19 eyes (10 with vitreous seeding), radiotherapy in 3 eyes, systemic chemotherapy in 1 eye, and local therapy in 1 eye. No severe systemic side effects occurred. Transient swelling of the eyelids (22 patients), conjunctival chemosis (12 patients), upper eyelid ptosis (5 patients), redness over the frontal area (3 patients), limitation of ocular motility (3 patients) and mild proptosis (1 patient) were detected. Retinal pigment epithelial alterations (30 patients) and optic atrophy (3 patients) were seen in the late follow-up. Conclusions: Globe salvage and avoidance of radiotherapy may be achieved by IACT with limited toxicity. This treatment is efficient, repeatable and safe.

scholarly journals Effectiveness of intravitreal chemotherapy-assisted endoresection in monocular patients with group D retinoblastoma

2020 ◽  
Author(s):  
Xiling Yu ◽  
Xueke Li ◽  
Yue Xing ◽  
Siduo Lu ◽  
Silvia Tanumiharjo ◽  
...  
Keyword(s):  
Pars Plana Vitrectomy ◽  
Case Series ◽  
Repeated Treatment ◽  
Retrospective Case ◽  
Promising Alternative ◽  
Tumour Control ◽  
Intravitreal Chemotherapy ◽  
Pars Plana ◽  
Group D

Abstract Background: This study aimed to determine the efficacy and complications of intravitreal chemotherapy-assisted endoresection for refractory International Classification of Retinoblastoma (ICRB) group D retinoblastoma in monocular patients.Methods: In this retrospective case series, intravitreal chemotherapy-assisted endoresection by pars plana vitrectomy was performed in 11 eyes with refractory ICRB group D retinoblastoma unresponsive to standard therapies in monocular patients.Results: Across a mean follow-up period of 42.7 months, globe salvage was attained in all 11 eyes (100%). There were no cases of extra-ocular tumour seeding or remote metastasis. In 9 eyes (81.8%), tumour control was achieved with one pars plana vitrectomy; in 2 cases (18.2%), repeated treatment, such as laser therapy, intravitreal chemotherapy or a second pars plana vitrectomy, was needed. Retinal reattachment was achieved in all 4 eyes (100%) with previous retinal detachment. Four eyes (36.4%) required subsequent cataract surgery due to secondary cataract. Ten eyes (90.9%) had improvement in best-corrected visual acuity at the last follow-up.Conclusion: Intravitreal chemotherapy-assisted endoresection appears to be a safe and effective globe-salvaging method for refractory group D retinoblastoma. It is a promising alternative to enucleation and a supplementary therapeutic strategy for those unresponsive to standard therapies, especially for the monocular retinoblastoma patients.

Macular Edema and Visual Loss after Macular Pucker Surgery with ICG-Assisted Internal Limiting Membrane Peeling

2005 ◽  
Vol 15 (2) ◽  
pp. 289-291 ◽  
Author(s):  
D. Tognetto ◽  
C. Haritoglou ◽  
A. Kampik ◽  
G. Ravalico
Keyword(s):  
Macular Edema ◽  
Visual Loss ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Cataract Extraction ◽  
Internal Limiting Membrane ◽  
Macular Pucker ◽  
Epiretinal Membranes ◽  
Pars Plana

Purpose To describe the occurrence of massive macular edema and visual loss after indocyanine green-assisted (ICG) macular pucker surgery. Methods/Results A 74 years old female presented with a macular pucker and a hypertrophy of the retinal pigment epithelium (RPE) in her left eye. The preoperative visual acuity (VA) was 20/100. Surgery consisted of cataract extraction, lens implantation and standard pars plana vitrectomy with peeling of epiretinal tissue followed by the removal of the internal limiting membrane (ILM) remnants stained using a 0.05% ICG solution. One day after surgery, VA was counting fingers. There was an extensive macular edema and retinal thickening with hyperfluorescence during fluorescein angiography and pronounced autofluorescence using ICG filters. During follow up, the macular edema resolved completely, but VA decreased to 20/800 at six months postoperatively. There was a central scotoma and unstable fixation seen during microperimetry. Discussion This case report indicates that ICG might come into contact with bare retina if injected following removal of epiretinal membranes. Whether the observed RPE hypertrophy might have contributed to the pathogenesis of the adverse effect described remains hypothetical.

Management of cataracts secondary to intravitreal chemotherapy injections for retinoblastoma seeding

2021 ◽  
pp. 112067212110233
Author(s):  
İrem Koç ◽  
Hande Taylan Şekeroğlu ◽  
Hayyam Kıratlı ◽  
Sepideh Lotfisadigh
Keyword(s):  
Cataract Surgery ◽  
Disease Free Survival ◽  
Preventive Measure ◽  
Tumor Control ◽  
Free Survival ◽  
Anterior Vitrectomy ◽  
Intravitreal Chemotherapy ◽  
Chemotherapy Administration ◽  
Age At Surgery

Purpose: To report our experience in the management of cataracts presumably due to intravitreal chemotherapy administration in eyes with vitreous disease associated with retinoblastoma. Methods: This retrospective study consisted of a cohort of five eyes of five retinoblastoma patients who developed cataracts secondary to intravitreal chemotherapy administration and who then underwent cataract surgery. All patients underwent lensectomy and anterior vitrectomy with/without intraocular lens implantation via clear corneal approach. All cases were administered intraoperative intravitreal melphalan (35–40 mcg) and topotecan (10–20 mcg) at the end of cataract surgery as a preventive measure against retinoblastoma spread. Injections were repeated as needed in monthly follow-ups. Main outcome measures were enucleation rate and disease-free survival time. Results: The age at surgery ranged between 5 and 10 years. Follow-up time varied from 12 to 16 months. Treatment-free period before surgery ranged between 3 and 20 months. Time from last injection to cataract detection was: 2, 2, 10, 6, and 7 months; and time from last injection to cataract surgery was: 8, 3, 20, 7, and 15 months in cases 1–5, respectively. None of the eyes required enucleation. Tumor control was achieved in all patients at the end of follow-up. Conclusions: Injection of melphalan and topotecan into anterior parts of the vitreous may lead to cataract formation. This can be safely managed with lensectomy and anterior vitrectomy and the use of intravitreal administration of melphalan and topotecan at the conclusion of the surgery as a precautionary measure against the potential risk of extraocular spread.

scholarly journals Safety and Efficacy of Intravitreal Chemotherapy (Melphalan) to Treat Vitreous Seeds in Retinoblastoma

2021 ◽  
Vol 12 ◽  
Author(s):  
Yacoub A. Yousef ◽  
Mays Al Jboor ◽  
Mona Mohammad ◽  
Mustafa Mehyar ◽  
Mario D. Toro ◽  
...  
Keyword(s):  
Tumor Response ◽  
Standard Dose ◽  
Complete Response ◽  
Complete Regression ◽  
Safety And Efficacy ◽  
Intravitreal Chemotherapy ◽  
Lost To Follow Up ◽  
Group D ◽  
Vitreous Seeds

Background: Active vitreous seeds in eyes with retinoblastoma (Rb) adversely affects the treatment outcome. This study aimed to investigate the safety and efficacy of intravitreal melphalan chemotherapy (IViC) as a treatment for recurrent and refractory vitreous seeds in patients with Rb.Methods: We used a retrospective non-comparative study of patients with intraocular Rb who had vitreous seeds and were treated by IViC (20–30 μg of melphalan) using the safety-enhanced anti-reflux technique. Tumor response, ocular toxicity, demographics, clinical features, and survival were analyzed.Results: In total, 27 eyes were treated with 108 injections for recurrent (16 eyes) or refractory (11 eyes) vitreous seeds after failed systemic chemotherapy. A total of 15 (56%) were males, and 20 (74%) had bilateral disease. At diagnosis, the majority (n = 21) of the injected eyes were group D, and n = 6 were group C. Vitreous seeds showed complete regression in 21 (78%) eyes; 100% (n = 10) for eyes with focal seeds; 65% (n = 11/17 eyes) for eyes with diffuse seeds (p = 0.04); 7 (64%) eyes with refractory seeds; and 14 (87%) eyes with recurrent seeds showed complete response (p = 0.37). In total, 16 (59%) eyes developed side effects: retinal toxicity (48%), pupillary synechiae (15%), cataracts (30%), iris atrophy (7%), and retinal and optic atrophy (4%). Only one child was lost to follow-up whose family refused enucleation and none developed orbital tumor recurrence or distant metastasis.Conclusion: IViC with melphalan is effective (more for focal than diffuse seeding) and a relatively safe treatment modality for Rb that can improve the outcomes of eye salvage procedures. However, unexpected toxicity can occur even with the standard dose of 20–30 μg.

Combination of brachytherapy and intravitreal chemotherapy in the treatment of retinoblastoma with vitreous seeding

2021 ◽  
Author(s):  
Sabrina Schlüter ◽  
Norbert Bornfeld ◽  
Elbrus Valiyev ◽  
Dirk Flühs ◽  
Martin Stuschke ◽  
...  
Keyword(s):  
Retention Rate ◽  
Serous Retinal Detachment ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
Tumour Control ◽  
Intravitreal Chemotherapy ◽  
The Mean ◽  
Vitreous Seeding

Purpose: To report the efficacy of combined intravitreal chemotherapy (IVC) and ruthenium-106 brachytherapy in retinoblastoma, either as first line or second line treatment following systemic chemoreduction or intraarterial chemotherapy. Methods: Retrospective data collection of 18 eyes from 18 patients treated with IVC and brachytherapy from August 2014 to December 2019. Results: The method described was our first line therapy in 6 patients, whereas it was used as second line treatment after chemoreduction in the remaining 12 patients. The eyes showed the following classification at initial presentation: 2 group B eyes, 3 group C eyes and 13 group D eyes. The mean follow-up was 19.5 months (range 2 – 53 months). Mean patient age at brachytherapy was 34.0 months (range 15 – 83 months). Median prescribed dose at the tumour base and apex was 574.5 ± 306.7Gy and 88.5 ± 12.2Gy, respectively. The ocular retention rate was 66.7%. Six eyes had to be enucleated due to uncontrollable subretinal and recurrent vitreous seeding, tumour relapse, recurrence of a solid tumour elsewhere in the eye and persistent vitreous bleeding with loss of tumour control. The mean number of intravitreal injections of Melphalan was 5.0. Two patients received a simultaneous injection of Topotecan for insufficient therapeutic response. With regard to radiogenic complications, we could observe temporary retinal and vitreous bleeding (27.8%), serous retinal detachment (44.4%) and radiogenic maculopathy and retinopathy (11.1%). None of the children showed metastatic disease during follow up. Conclusion: Ruthenium-106 plaque therapy in combination with intravitreal chemotherapy is an effective local therapy with good tumour control rates even in advanced eyes. Overall, the analysed therapeutic approach shows an acceptable side effect profile, especially when considering that EBRT and systemic polychemotherapy, or at least the number of cycles needed, with their increased incidence of adverse events can thus be avoided.

scholarly journals Intravitreal Melphalan Chemotherapy for Vitreous Seeds in Retinoblastoma

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Yacoub A. Yousef ◽  
Amal M. Noureldin ◽  
Iyad Sultan ◽  
Rasha Deebajah ◽  
Maysa Al-Hussaini ◽  
...  
Keyword(s):  
Case Series ◽  
Complete Response ◽  
Retinal Toxicity ◽  
Treatment Modalities ◽  
Injection Technique ◽  
Stage At Diagnosis ◽  
Retrospective Case ◽  
Salvage Rate ◽  
Vitreous Seeds

Objective. To evaluate our experience with intravitreal melphalan chemotherapy as a second-line regimen for RB patients with refractory or recurrent vitreous seeds. Methods. A retrospective case series of 16 eyes from 16 patients with intraocular RB who received intravitreal melphalan chemotherapy using the antireflux injection technique. Data included demographics, stage at diagnosis, treatment modalities, side effects, eye salvage, and survival. Results. The total number of injections was 64 (median, 3 injections per eye; range, 3–8), and the median age at time of injection was 22 months (range, 9–63 months). Nine (56%) patients were males, and 13 (81%) patients had bilateral RB. Complete response was seen in 13 (81%) eyes: in 9 (100%) eyes with focal vitreous seeds and in 4 (57%) eyes with diffuse vitreous seeds (P=0.062). At a median follow-up of 18 months (range, 6–48 months), the eye salvage rate was 81%, local retinal toxicity confined to the site of injection was seen in 2/3 of the eyes, 2 (12%) eyes had cataract, and none of the patients had orbital recurrence and distant metastasis or was dead. Conclusion. Intravitreal melphalan is a promising modality for treatment of vitreous seeds, and the dose of 20–30 μg of melphalan sounds to be safe and effective for refractory and recurrent vitreous seeds.

scholarly journals Primary Intra-Arterial Chemotherapy for Retinoblastoma in the Intravitreal Chemotherapy Era: Five Years of Experience

2018 ◽  
Vol 5 (2) ◽  
pp. 139-146 ◽  
Author(s):  
Lauren A. Dalvin ◽  
Mamta Kumari ◽  
Vera Adobea Essuman ◽  
Shormin Shohelly Shipa ◽  
David  Ancona-Lezama ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Retrospective Review ◽  
Tumor Control ◽  
Primary Therapy ◽  
Years Of Experience ◽  
Intravitreal Chemotherapy ◽  
Group B ◽  
Group D ◽  
Unilateral Group ◽  
Vitreous Seeds

Purpose: To report our 5-year experience with intra-arterial chemotherapy (IAC) in the intravitreal chemotherapy (IvitC) era. Methods: Retrospective review of retinoblastoma treated with primary unilateral IAC in the IvitC era (2012–2017). Results: There were 34 eyes treated with IAC alone versus 20 eyes treated with IAC plus IvitC for vitreous seeds. IAC (IAC alone vs. IAC plus IvitC) consisted of melphalan (41 vs. 10%) or melphalan plus topotecan (59 vs. 90%, p = 0.03). IvitC consisted of melphalan (60%) or melphalan plus topotecan (40%). Tumor control and globe salvage were achieved in 100% of group B and C eyes without IvitC. Despite more extensive vitreous seeds in the IvitC group (p < 0.01), comparison of IAC alone versus IAC plus IvitC revealed no difference in tumor control for group D (88 vs. 69%, p = 0.36) or group E (67 vs. 100%, p = 0.25) and no difference in globe salvage for group D (88 vs. 69%, p = 0.36) or group E (58 vs. 57%, p = 0.39). Conclusions: IAC is effective as primary therapy for unilateral group B, C, D, and E retinoblastoma. IvitC is an important adjuvant therapy to achieve comparable globe salvage rates for group D and E eyes with persistent active vitreous seeds.

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