melphalan and Retinal-Detachment

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

Tractional retinal detachment with or without secondary tear is a rare complication reported in less than 0.5% of in eyes treated for retinoblastoma. Pars plana vitrectomy (PPV) in eyes with history of retinoblastoma has been associated with a significant risk for recurrence, extraocular spread, and systemic metastases. We report here the successful management by PPV under melphalan irrigation of 2 children presenting with tractional retinal detachment after retinoblastoma therapy and scleral buckle surgery.. A 7-year-old girl with a history of bilateral retinoblastoma (group D) presented with light perception best-corrected visual acuity (BCVA) and tractional retinal detachment (RD) in her left eye, 3 years after the last intra-arterial chemotherapy (IAC) injection. Moreover, she had history of left eye rhegmatogenous RD treated by scleral buckle 1 month after the last IAC and cataract surgery 12 months later. PPV associated with retinectomy, laser photocoagulation and silicone oil tamponade was performed. Silicone oil was removed 4 months later. Fifteen months after PPV, BCVA had increased to 20/32 without recurrence of RD and no evidence of tumor activity. A 7-year-old boy with a history of unilateral retinoblastoma (group D) in his left eye presented with rhegmatogenous RD 21 months after the last treatment for retinoblastoma. Scleral buckle surgery was performed, but 3 weeks later the patient presented with tractional RD associated with proliferative vitreo-retinopathy. BCVA was counting fingers. PPV associated with membrane peel, laser photocoagulation and silicone oil tamponade was performed. Silicone oil was removed after 5 months followed by cataract surgery 5 months later. Twenty months after PPV, BCVA was 20/20 and there was no sign of tumor recurrence.. PPV under melphalan irrigation, with retinectomy, if necessary, and silicone oil tamponade, allows anatomical and functional improvement in eyes with history of retinoblastoma and scleral buckling developing tractional RD.

Topics: Child; Child, Preschool; Female; Humans; Male; Melphalan; Myeloablative Agonists; Retinal Detachment; Retinal Neoplasms; Retinoblastoma; Therapeutic Irrigation; Tomography, Optical Coherence; Vitrectomy

A 35-month-old boy was diagnosed with retinoblastoma and underwent combination intra-arterial (IAC) and intravitreal chemotherapy. His course was complicated by anaphylactic reaction to IAC, yet he continued to improve with sustained intravitreal therapy. Eight months into treatment, the affected eye developed exudative retinal detachment, which resolved with sub-Tenon's steroid administration. As the management of retinoblastoma evolves, treaters need to be aware of potential complications of therapy. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:248-252.].

Topics: Antineoplastic Agents, Alkylating; Child, Preschool; Drug Therapy, Combination; Fluorescein Angiography; Follow-Up Studies; Fundus Oculi; Humans; Injections, Intraocular; Intravitreal Injections; Macula Lutea; Male; Melphalan; Retinal Detachment; Retinal Neoplasms; Retinoblastoma; Topoisomerase I Inhibitors; Topotecan; Triamcinolone Acetonide; Ultrasonography

To report on the rate and timing of retinal reattachment and outcomes for retinoblastoma children who have total retinal detachments at presentation to our center and were treated with intra-arterial chemotherapy (ophthalmic artery chemosurgery, OAC).. Single-center retrospective review of retinoblastoma patients who presented with total retinal detachments and were subsequently treated with OAC at MSKCC between May 2006 and July 2016. Endpoints were retinal detachment resolution, visual function, ERG amplitude, ocular survival, and patient survival from metastases.. 87 eyes of 84 retinoblastoma patients were included. Using a survival multistate model, by 36 months of follow-up, there was a 54% cumulative probability of complete retinal reattachment and a 76% probability of partial reattachment. 24% of eyes that completely reattached received only OAC without any prior or adjuvant treatments. Eyes that completely reattached were significantly more likely to have been diagnosed at a younger age (p<0.0001) and to have greater initial ERG values (p = 0.006). At final follow-up, 14% of eyes had gained at least 25 μV of ERG activity, and 8.0% had achieved hand motion vision or better, including one to 20/60. 13% of eyes were enucleated. No patient died from metastatic disease, and only one developed metastases.. OAC can successfully treat previously considered "non-salvageable" retinoblastoma eyes with total retinal detachments, promote retinal reattachment in the majority of eyes, and preserve ocular and patient survival.

Topics: Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Carboplatin; Child, Preschool; Electroretinography; Female; Follow-Up Studies; Humans; Infant; Infusions, Intra-Arterial; Male; Melphalan; Ophthalmic Artery; Retina; Retinal Detachment; Retinal Neoplasms; Retinoblastoma; Retrospective Studies; Survival Analysis; Topotecan; Treatment Outcome

To report retinal function outcomes after ophthalmic artery chemosurgery (OAC) for advanced retinoblastoma (RB) in eyes with minimal pretreatment retinal function.. For 72 advanced RB eyes with baseline electroretinograms (ERGs) indistinguishable from noise ('extinguished') or flicker ERG amplitudes <25 µV ('poor'), ERGs were obtained before OAC and at 3 months, 1 year and 2 years after OAC. Presence of baseline retinal detachments (RDs) and their subsequent resolution or persistence was also noted.. Minimal baseline ERGs do not preclude significant recovery of retinal function after OAC. Good correlation exists between ERG outcomes at 3 months and those at subsequent follow-ups, suggesting that ERG amplitudes at 3-month post-OAC can prognosticate longer term retinal function, and that improvement is durable. For eyes presenting with RD, RD resolution is necessary but not sufficient for significant (≥25 μV) increases in ERG amplitudes.

Topics: Antineoplastic Agents; Child; Disease-Free Survival; Electroretinography; Female; Humans; Infusions, Intra-Arterial; Male; Melphalan; Ophthalmic Artery; Retinal Detachment; Retinal Neoplasms; Retinoblastoma; Retrospective Studies; Salvage Therapy

Intra-arterial melphalan chemotherapy (IAC) continues to demonstrate excellent utility in the treatment of retinoblastoma. We present the case of a 3-month-old boy diagnosed with with unilateral, advanced stage 5B retinoblastoma and a Coats' response in the right eye. After laser therapy he received 3 doses of IAC. Intraretinal hemorrhaging, first noted after the second dose and worsening after the third, preceded complex exudative retinal detachment. With little visual potential and evidence of atropy, the eye was enucleated. This case illustrates that intraretinal hemorrhage may serve as an early predictor of treatment failure.

Topics: Antineoplastic Agents, Alkylating; Eye Enucleation; Humans; Infant; Infusions, Intra-Arterial; Male; Melphalan; Neoplasm Seeding; Neoplasm Staging; Retinal Detachment; Retinal Hemorrhage; Retinal Neoplasms; Retinoblastoma; Treatment Failure; Visual Acuity; Vitreous Body

We present a description of retinoblastoma treated with supraselective intra-arterial chemotherapy, demonstrating selective delivery of the infused chemotherapeutic agent into the tumor bed by MRI. A 7-month-old presented with group E (international classification) unilateral retinoblastoma. We treated the patient with several rounds of intra-ophthalmic artery melphalan. Gadolinium was infused along with melphalan to visualize the distribution of this chemotherapeutic drug. Intraoperative MRI was obtained within 15 min after treatment and showed increased enhancement of the tumor and subretinal space. We demonstrate here that supraselective administration of chemotherapy into the ophthalmic artery appears to result in drug delivery to the tumor and subretinal space.

Topics: Antineoplastic Agents, Alkylating; Cerebral Angiography; Contrast Media; Drug Delivery Systems; Follow-Up Studies; Gadolinium; Humans; Infant; Injections, Intra-Arterial; Intraoperative Period; Magnetic Resonance Angiography; Male; Melphalan; Retinal Artery; Retinal Detachment; Retinal Neoplasms; Retinoblastoma; Treatment Outcome; Visual Acuity

To assess potential retinal viability by electroretinography following selective ophthalmic artery chemotherapy infusion for retinoblastoma.. Uncontrolled prospective case series. Patients with advanced retinoblastoma were offered elective ophthalmic artery chemotherapy infusion treatment under an IRB-approved protocol as an alternative to enucleation. The ophthalmic artery was cannulated under fluoroscopic control, and chemotherapeutic agents (melphalan and occasionally carboplatin) were directly infused at doses resulting in very high local tissue concentrations, but low systemic drug levels. Eyes were examined under anesthesia at 1-month intervals, and re-treated as indicated, up to a maximum of six infusions. Electroretinograms were obtained during examination under anesthesia, using ERG-jet contact lens electrodes and a hand-held mini-ganzfeld stimulator. The ERG protocol was similar to ISCEV standards except for briefer adaptation times as necessary to reduce the total anesthesia duration.. We report initial results in the first ten patients attempted. Nine eyes were successfully cannulated and perfused. ERG data for these nine patients are reported. [Clinical results have been published elsewhere.] Follow up ranged from 3 to 14 months. Extensive, often total, retinal detachments were present in many of the treated eyes. While regression of tumor mass and vitreous seeds was observed in nearly all the patients, retinal detachment occasionally persisted. ERG responses were extinguished in these eyes. Eyes with largely attached retinas, notwithstanding the presence of large tumors at baseline, remained free of detachment after treatment. Normal or near-normal ERGs in these eyes were repeatedly obtained. Recovery of ERG amplitudes was observed in three patients following treatment.. Retinal function can persist and even recover following selective ophthalmic artery chemotherapy infusion for retinoblastoma. Further work is indicated to determine optimal dosing regimens, maximal tolerated dosage, and subsequent visual function in these patients.

Topics: Adult; Antineoplastic Agents; Antineoplastic Agents, Alkylating; Carboplatin; Cohort Studies; Electroretinography; Follow-Up Studies; Fundus Oculi; Humans; Infant; Infusions, Intra-Arterial; Melphalan; Ophthalmic Artery; Retina; Retinal Detachment; Retinal Neoplasms; Retinoblastoma

A 52-year-old patient with atypical plasmocytoma presented with a bilateral serous detachment of the retina as well as a huge detachment of the pigment epithelium (PE) in the periphery. Shortly thereafter the PE ruptured. In the left eye this led to substantial central macular fibrosis.. The clinically healthy patient showed a nephrotic syndrome; neither typical monoclonality was detectable nor was erythropoiesis or myelopoiesis reduced.. To avoid further reduction of VA pars plana vitrectomy (ppV) with silicone oil tamponade and laser coagulation was performed. Clinical findings were reduced significantly and VA was stabilized for 2.5 years.. PE detachments and serous retinal detachments in patients with nephrotic syndrome are only mentioned in a few cases. However, a peripheral rupture of the PE to this extent seems to be very rare. Early ppV with silicone oil and laser coagulation may prevent further macular fibrosis.

Topics: Antineoplastic Combined Chemotherapy Protocols; Choroidal Neovascularization; Comorbidity; Female; Fluorescein Angiography; Follow-Up Studies; Humans; Kidney Neoplasms; Laser Coagulation; Lenses, Intraocular; Melphalan; Middle Aged; Nephrotic Syndrome; Ophthalmoscopy; Plasmacytoma; Postoperative Complications; Prednisolone; Recurrence; Renal Insufficiency; Reoperation; Retinal Detachment; Retinal Perforations; Silicone Oils; Visual Acuity; Vitrectomy

Bilateral exudative macular detachments were present on a 64-year-old diabetic Caucasian male who presented with bilateral blurring of vision. Besides the exudative macular detachments there was no diabetic retinopathy or congestive retinopathy, and a previous fluorescein angiogram revealed no focal leakage. Laboratory investigation, bone marrow biopsy, and a bone survey revealed the diagnosis of multiple myeloma.

Topics: Diabetes Mellitus, Type 1; Exudates and Transudates; Humans; Macula Lutea; Male; Melphalan; Middle Aged; Multiple Myeloma; Plasmapheresis; Prednisolone; Retinal Detachment; Visual Acuity