Anterior Chamber Chemotherapy in Retinoblastoma—Necessary but Not Sufficient for Aqueous Seeding Control

Abstract

purpose of the article was to cohesively review prescribing patterns of opioid medications by ophthalmologists in the midst of an epidemic. It is important to understand the context in which the article analysis was conducted. The study represents a review of prescribing practices among US ophthalmologists to recipients of Medicare Part D (outpatient) benefits.The article by Kim et al 2 looks at pain control in the immediate postoperative setting for enucleation and evisceration surgery using opioids administered intravenously by patient-controlled analgesia. The article by Wishaw et al 3 looks at intraoperative analgesic supplementation with peribulbar morphine. These 2 articles, while supporting the value of opioids intraoperatively and intravenously in the immediate postoperative period, do not address the issue of opioid prescribing in the outpatient setting.We want to take this opportunity to reinforce the conclusions of our study. Specifically, an overwhelming number of ophthalmologists prescribe opioids responsibly. Additionally, we fully recognize the importance and efficacy of opioids in controlling patient pain. However, as supported by the review of neuropathic corneal pain by Dieckman et al, 4 we also recognize the benefit of nonopioid analgesics in controlling ocular pain. The purpose of our article was not to discourage the prescription of opioid pain medication for patients who have unremitting pain. Rather, we encourage ophthalmologists to review their opioid prescribing patterns and consider alternative agents for first-line treatment when the available literature points to their efficacy in treating ocular pain.

Aqueous seeding in intraocular retinoblastoma: A review

“…Intracameral chemotherapy to AC alone may cause aqueous relapse due to undertreatment of aqueous seeds in posterior chamber, secondary to drug dilution by aqueous humour dynamics and possible inverse retroiridolenticular block during intracameral injection into AC 17,41 . A child treated with intra‐arterial chemotherapy for retinal tumour, intravitreal chemotherapy for vitreous seeds, and AC intracameral chemotherapy for AC seeds had aqueous relapse in 3.5 months 17 .…”

“…Based on available literature and evidence for intra‐vitreal and intracameral chemotherapy, 17,37–43 and this author's professional experience, the following recommendations are made:…”

<p>A temperature-sensitive phase-change hydrogel of topotecan achieves a long-term sustained antitumor effect on retinoblastoma cells</p>

“…Retinoblastoma (Rb) is one of the most common malignancies among children. Following early diagnosis and prompt treatment, the clinical outcome or prognosis of Rb is promising 1–4. However, the prognosis or survival rates of patients with late-stage Rb remains poor 5–7.…”