玻璃体腔注射马法兰治疗视网膜母细胞瘤难治性玻璃体种植短期疗效观察

Short-term efficacy of intravitreal injection of melphalan for refractory vitreous seeding from retinoblastoma

目的观察玻璃体腔注射马法兰治疗视网膜母细胞瘤（RB）难治型玻璃体种植的疗效和安全性。方法回顾性系列病例研究。收集2014年3月至2015年10月在复旦大学附属眼耳鼻喉科医院就诊确诊的9例（13只眼）RB难治型玻璃体种植患者的临床资料。其中，男性6例，女性3例。患儿年龄8至40个月，中位数年龄18个月。13只眼中3只眼为E期，9只眼为D期，1只眼为C期。间接眼底镜眼底检查，RetcamⅢ照相记录并绘制详细的眼底情况。全身化学治疗采用VEC方案，即长春新碱、依托泊甙、卡铂。局部治疗还包括冷冻和（或）经瞳孔温热疗法。患者均进行玻璃体腔注射马法兰治疗，每4周1次，平均治疗3次。马法兰治疗剂量每次为20-40 μg。观察玻璃体种植控制和并发症情况。结果13只眼的RB玻璃体种植均得以控制，无一例发生眼眶或全身转移。13只眼中局部不良反应包括视网膜脉络膜萎缩7只眼（53.8%）；瞳孔后粘、虹膜萎缩2只眼（15.4%）；血管炎、血管闭塞2只眼（15.4%）；视神经萎缩2只眼（15.4%）；玻璃体出血等1只眼（7.7%）及一过性低眼压3只眼（23.1%）。结论玻璃体腔注射马法兰治疗RB难治型玻璃体种植有较好疗效，较高剂量的马法兰可能会导致局部不良反应。

ObjectiveTo evaluate the efficacy and safety of intravitreal chemotherapy for refractory vitreous seeding from retinoblastoma.MethodsRetrospective series of case studies. Nine patients （13 eyes） with the diagnosis of refractory vitreous seeding were enrolled in Department of Ophthalmology of Eye＆ ENT Hospital of Fudan University from March 2014 to October 2015.There were 6 males and 3 females. Children aged 8 to 40 months, median age of 18 months. In the 13 eyes, 3 eyes were E period, 9 eyes were D period, and 1 eyes were C period. The fundus was examined by indirect ophthalmoscope and recorded by RetcamIII. Systemic chemotherapy was performed using the VEC protocol, that is vincristine, etoposide, and carboplatin. Local treatment also involves cryotherapy and/or thermotherapy. All patients were treated with intravitreal injection of melphalan. They underwent intravitreal melphalan, once every 4 weeks, with an average of 3 times of injections. The treatment dose of melphalan is 20 to 40 μg per dose. Observe the vitreous seed control and complications of therapy.ResultsVitreous seeds control was attained in all cases. There was no case of orbital extension or remote metastasis. Complications included retinal pigment epithelial and choroidal atrophy in 7 eyes, pupillary synechia and iris atrophy in 2 eyes,retinal vasculitis and vascular occlusion in 2 eyes, optic atrophy in 2 eyes, vitreous hemorrhage in 1 eye, and temporary hypotony in 3 eyes.ConclusionsIntravitreal melphalan is an effective treatment for refractory vitreous seeding from retinoblastoma. High dose may lead to local adverse reactions.