AIM： To evaluate the safety and efficacy of posterior sub-Tenon＇s carboplatin injection compared to intravitreal melphalan injection in the management of retinoblastoma （RB） with secondary vitreous seeds. The outc...AIM： To evaluate the safety and efficacy of posterior sub-Tenon＇s carboplatin injection compared to intravitreal melphalan injection in the management of retinoblastoma （RB） with secondary vitreous seeds. The outcome measures were vitreous seeds regression, need for other treatment modalities to achieve ocular salvage and treatment side effects. METHODS： A prospective interventional comparative nonrandomized study included RB eyes developed secondary vitreous seeds during the period of follow up. They subdivided into two groups： study group Ⅰ where posterior sub-Tenon＇s carboplatin （20 mg/2 mL） was injected and study group Ⅱ where intravitreal melphalan （20 μg/0.1 mL） was injected. The injections repeated every 2-4wk. RESULTS： Thirty-three eyes were included in the study. Seventeen eyes （16 patients） in study group Ⅰ and 16 eyes （16 patients） in study group Ⅱ. Ten eyes （30.3%） were completely salvaged following local chemotherapies, Ocular salvage was 23.5% following posterior sub-Tenon＇s carboplatin injection versus 37.5% following intravitreal melphalan raised to 47.1% and 75% with addition of external beam radiotherapy （EBR） with no statistically significant difference between the study groups （P=0.16）. A statistically significant correlation was found between ocular salvage rate and type of vitreous seeds either dust, spheres and clouds （r=0.42, P=-0.015） and eyes harbor new solid tumor growth （r=0.35, P=0.045）. The mean and median follow up periods following local chemotherapy injections were 2.0y in the study group Ⅰand 2.37y in the study group Ⅱ. Few complications were reported： periorbital edema in all eyes and ocular motility disturbances in 13 eyes （76.5%） following posterior sub-Tenon＇s carboplatin injection. Vitreous hemorrhage developed in 2 eyes （12.5%） and localized retinopathy in 5 eyes （31.25%） following intravitreal melphalan. ~ CONCLUSION： Local chemotherapy for treatment of RB with secondary vitreous seeds is safe and can salvage 30.3% of eyes without EBR. There is a superiority of intravitreal melphalan in ocular salvage however, no statistically significant difference between both groups.展开更多
ccordmg to Reese-Ellsworth Classification tot .retmoblastoma, retinoblastoma with vitreousseeding initially is grade 5B with poor prognosis and was proposed tbr enucleation. Chemotherapy combined with local treatment...ccordmg to Reese-Ellsworth Classification tot .retmoblastoma, retinoblastoma with vitreousseeding initially is grade 5B with poor prognosis and was proposed tbr enucleation. Chemotherapy combined with local treatment for retinoblasloma has been proposed as conservative treatment.1 Because of the lack of blood supply to vitreous seeding, the chemotherapy drugs could not reach the vitreous body through blood-retinal barrier. This has been one of the important limiting factors in the treatment of children with retmoblastoma with vitreous seeding.展开更多
文摘AIM： To evaluate the safety and efficacy of posterior sub-Tenon＇s carboplatin injection compared to intravitreal melphalan injection in the management of retinoblastoma （RB） with secondary vitreous seeds. The outcome measures were vitreous seeds regression, need for other treatment modalities to achieve ocular salvage and treatment side effects. METHODS： A prospective interventional comparative nonrandomized study included RB eyes developed secondary vitreous seeds during the period of follow up. They subdivided into two groups： study group Ⅰ where posterior sub-Tenon＇s carboplatin （20 mg/2 mL） was injected and study group Ⅱ where intravitreal melphalan （20 μg/0.1 mL） was injected. The injections repeated every 2-4wk. RESULTS： Thirty-three eyes were included in the study. Seventeen eyes （16 patients） in study group Ⅰ and 16 eyes （16 patients） in study group Ⅱ. Ten eyes （30.3%） were completely salvaged following local chemotherapies, Ocular salvage was 23.5% following posterior sub-Tenon＇s carboplatin injection versus 37.5% following intravitreal melphalan raised to 47.1% and 75% with addition of external beam radiotherapy （EBR） with no statistically significant difference between the study groups （P=0.16）. A statistically significant correlation was found between ocular salvage rate and type of vitreous seeds either dust, spheres and clouds （r=0.42, P=-0.015） and eyes harbor new solid tumor growth （r=0.35, P=0.045）. The mean and median follow up periods following local chemotherapy injections were 2.0y in the study group Ⅰand 2.37y in the study group Ⅱ. Few complications were reported： periorbital edema in all eyes and ocular motility disturbances in 13 eyes （76.5%） following posterior sub-Tenon＇s carboplatin injection. Vitreous hemorrhage developed in 2 eyes （12.5%） and localized retinopathy in 5 eyes （31.25%） following intravitreal melphalan. ~ CONCLUSION： Local chemotherapy for treatment of RB with secondary vitreous seeds is safe and can salvage 30.3% of eyes without EBR. There is a superiority of intravitreal melphalan in ocular salvage however, no statistically significant difference between both groups.
文摘ccordmg to Reese-Ellsworth Classification tot .retmoblastoma, retinoblastoma with vitreousseeding initially is grade 5B with poor prognosis and was proposed tbr enucleation. Chemotherapy combined with local treatment for retinoblasloma has been proposed as conservative treatment.1 Because of the lack of blood supply to vitreous seeding, the chemotherapy drugs could not reach the vitreous body through blood-retinal barrier. This has been one of the important limiting factors in the treatment of children with retmoblastoma with vitreous seeding.
