melphalan and Atrophy

To describe the ocular side effects in patients receiving intravitreal injection therapy (IViT) for retinoblastoma.. PubMed (1946-present), Scopus (all years), Science Citation Index (1900-present) and Conference Proceedings Citation Index-Science (1990-present) electronic databases were searched to identify all published reports of therapeutic intravitreal injections for retinoblastoma in humans.. Ten studies with original IViT ocular side effect data were included in this systematic review. In these combined reports, a total of 1287 intravitreal injections were given to 306 eyes of 295 patients, with a mean follow-up of 74.1 months. Two hundred sixty-one (88.5%) patients received comparatively standard melphalan IViT doses (8-30 mcg). Ocular side effects occurred in 38 patients (17 significant, 21 minor). The proportion of patients experiencing potentially significant ocular side effects following standard melphalan IViT regimens was 0.031 (8/261; 95% CI 0.013 to 0.06). The side effects of these eight included iris atrophy in three, two each with chorioretinal atrophy and vitreous haemorrhage and one with retinal detachment. Of the other nine patients with significant complications, five experienced sight-threatening complications following dramatic dose escalations (four with melphalan, one with thiotepa), three experienced complications that are commonly associated with concurrent therapies given to these patients and one had a retinal detachment. Of the 61 patients receiving IViT via safety-enhancing injection techniques, all six significant side effects were either attributed to the therapeutic dose or confounded by concurrent treatments.. Significant ocular complications following IViT for retinoblastoma are uncommon, and this risk may be reduced further by the use of careful injection technique and standard dosing regimens. Care must be taken in the dosing of intravitreal treatments to avoid potentially irreversible vision loss.

Topics: Antineoplastic Agents, Alkylating; Atrophy; Corneal Dystrophies, Hereditary; Humans; Intravitreal Injections; Iris; Melphalan; Retinal Detachment; Retinal Neoplasms; Retinoblastoma; Vitreous Hemorrhage

Controlling retinoblastoma with seeding is challenging despite advances in treatment modalities. Intravitreal melphalan is an alternative to external beam radiation or enucleation for recurrent or refractory vitreous seeds. Significant ocular side effects following intravitreal melphalan injections are uncommon. Complications have been reported in eyes receiving higher concentrations of melphalan and repetitive injections. We report a case in which diffuse chorioretinal atrophy was developed at the injection site after a single, standard low-dose intravitreal melphalan injection.. A 12-month-old female child without a family history of retinoblastoma presented with unilateral group C retinoblastoma in her right eye. A solitary tumour with retinal breaks on the tumour surface, and vitreous seeds overlying the tumour were observed at the 8 o'clock position of the retina. After two cycles of intra-arterial chemotherapy with melphalan, the main tumour displayed significant regression, but the vitreous seeds overlying the main tumour were still active. Because of the persistence of vitreous seeds and the inadequate response to intra-arterial melphalan treatment, intravitreal melphalan (8 μg in 0.05 mL) was injected using a 32-gauge needle 2.5 mm from the 5 o'clock position of the limbus, the meridian opposite to the vitreous seeds. After 1 month, the retina around the injection site demonstrated diffuse retinal pigment epithelium alterations with dense hard exudates. Although the main retinal mass, and vitreous seeds resolved, the hard exudates persisted for more than 2 years after the single low-dose melphalan injection.. Intravitreal melphalan injections should be cautiously used for eyes with refractory seeds, particularly when multiple injections are required to control retinoblastoma seeds. Dose- related retinal toxicity could occur in pre-treated eyes even when a relatively low standard dose is used. Such patients should be followed up closely to monitor the treatment response and to assess potential delayed toxicity.

Topics: Antineoplastic Agents, Alkylating; Atrophy; Female; Humans; Infant; Intravitreal Injections; Melphalan; Retina; Retinal Dystrophies; Retinal Neoplasms; Retinoblastoma

Topics: Antineoplastic Agents, Alkylating; Antineoplastic Combined Chemotherapy Protocols; Atrophy; Chemotherapy, Cancer, Regional Perfusion; Choroid; Choroid Diseases; Combined Modality Therapy; Diseases in Twins; Enophthalmos; Female; Fluorescein Angiography; Humans; Infant; Laser Coagulation; Magnetic Resonance Imaging; Melphalan; Ophthalmic Artery; Retinal Neoplasms; Retinoblastoma; Scleritis; Topoisomerase I Inhibitors; Topotecan; Twins, Monozygotic

To measure the choroidal thickness (CT) and analyze the morphologic features of chorioretinal structures using a portable handheld spectral domain-optical coherence tomography in patients with retinoblastoma after intraarterial chemotherapy.. This was a case-control study. Eighteen eyes of 9 patients with unilateral retinoblastoma treated with intraarterial chemotherapy were assessed by spectral-domain optical coherence tomography. Submacular CT was measured at the foveola and at points located 500 μm and 2 mm from the foveola. The treated eye was compared with the untreated (control) eye.. Mean submacular CT was 174 ± 111.1 μm in the treated eyes and 259 ± 42.2 μm in the control eyes (P = 0.054). Several point locations showed statistically significant differences comparing CT (treated eye vs. control eye), including subfoveolar (P = 0.030), nasal 0.5 mm (P = 0.037), nasal 2 mm (P = 0.049), and temporal 2 mm (P = 0.031). In 4 patients with ophthalmoscopically visible choroidal atrophy, submacular CT was reduced by 73.3 ± 14.1% compared with the control eye. In 5 patients with no ophthalmoscopically visible choroidal atrophy, submacular CT was reduced by 0.5 ± 11.9% compared with the control eye.. Intraarterial chemotherapy for retinoblastoma can cause reduction in subfoveolar CT. Spectral-domain optical coherence tomography confirmed choroid to be thinned in eyes with or without clinical evidence of choroidal atrophy.

Topics: Antineoplastic Combined Chemotherapy Protocols; Atrophy; Case-Control Studies; Child; Child, Preschool; Choroid; Female; Fluorescein Angiography; Humans; Infant; Infusions, Intra-Arterial; Male; Melphalan; Organ Size; Retinal Neoplasms; Retinoblastoma; Tomography, Optical Coherence; Topotecan

Superselective ophthalmic artery chemotherapy (SOAC) has recently been proposed as an alternative to intravenous chemoreduction for advanced intraocular retinoblastoma. Preliminary results appear promising in terms of tumor control and eye conservation, but little is known regarding ocular toxicity and visual prognosis. In this study, we report on the vascular adverse effects observed in our initial cohort of 13 patients.. The charts of 13 consecutive patients with retinoblastoma who received a total of 30 injections (up to 3 injections of a single agent per patient at 3-week interval) of melphalan (0.35 mg/kg) in the ophthalmic artery between November 2008 and June 2010 were retrospectively reviewed. RetCam fundus photography and fluorescein angiography were performed at presentation and before each injection. Vision was assessed at the latest visit.. Enucleation and external beam radiotherapy could be avoided in all cases but one, with a mean follow-up of 7 months. Sectoral choroidal occlusive vasculopathy leading to chorioretinal atrophy was observed temporally in 2 eyes (15%) 3 weeks to 6 weeks after the beginning of SOAC and retinal arteriolar emboli in 1 eye 2 weeks after injection. There was no stroke or other clinically significant systemic side effects except a perioperative transient spasm of the internal carotid artery in one patient. Vision ranged between 20/1600 and 20/32 depending on the status of the macula.. Superselective ophthalmic artery chemotherapy was effective in all patients with no stroke or other systemic vascular complications. Unlike intravenous chemoreduction, SOAC is associated with potentially sight-threatening adverse effects, such as severe chorioretinal atrophy secondary to subacute choroidal occlusive vasculopathy or central retinal artery embolism, not to mention the risk of ophthalmic artery obstruction, which was not observed in this series. Further analysis of the risks and benefits of SOAC will define its role within the therapeutic arsenal. Meanwhile, we suggest that SOAC should be given in one eye only and restricted to advanced cases of retinoblastoma, as an alternative to enucleation and/or external beam radiotherapy.

Topics: Antineoplastic Agents, Alkylating; Atrophy; Chemotherapy, Cancer, Regional Perfusion; Child, Preschool; Choroid; Choroid Diseases; Fluorescein Angiography; Humans; Infant; Melphalan; Ophthalmic Artery; Photography; Retinal Artery Occlusion; Retinal Neoplasms; Retinoblastoma; Retrospective Studies; Visual Acuity

Gelatinous transformation of the marrow (GTBM) has been associated with various conditions. We present a unique case of GTBM in a patient with myeloma following treatment with Melphalan.

Topics: Antineoplastic Agents, Alkylating; Antineoplastic Combined Chemotherapy Protocols; Atrophy; Biopsy; Bone Marrow; Gelatin; Humans; Leukemia, Myeloid, Acute; Male; Melphalan; Middle Aged