Intravitreal injection of melphalan for intraocular retinoblastoma

Suzuki, Shigenobu; Aihara, Yukiko; Fujiwara, Masaru; Sano, Shuichi; Kaneko, Akihiro

doi:10.1007/s10384-015-0378-0

Cited by 68 publications

(50 citation statements)

References 22 publications

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“…Intravitreal delivery of chemotherapy is not without its own set of side effects, including retinal toxicity as described by Munier [14]. Suzuki et al [22] reported findings for anterior toxicity, including iris atrophy and dense cataracts, in 8.7% of eyes (23/264) and diffuse chorioretinal atrophy in 0.8% of eyes (2/264). Ghassemi and Shields [23] reported RPE changes, cataracts, and phthisis in 25% of eyes (3/12).…”

Section: Discussionmentioning

confidence: 95%

Integrated Treatment during the Intravitreal Melphalan Era: Concurrent Intravitreal Melphalan and Systemic Chemoreduction

et al. 2018

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Background: Intravitreal injection of melphalan (IVM) is safe and effective for the treatment of seeding in retinoblastoma. Current protocols require weekly injections during examination under anesthesia (EUA). To avoid additional anesthesia exposure for these children, IVM was initiated at the EUA concurrent with the 4th cycle of systemic chemoreduction in a series of 6 patients with persistent seeding. Methods: A retrospective review was completed to assess treatment response compared to all patients at our center treated with IVM and systemic chemotherapy. Overall, 6 eyes of 6 patients were included; salvage therapy included systemic chemoreduction with vincristine, etoposide, and carboplatin and IVM for persistent seeding. Results: IVM was initiated in all eyes at cycle 4 of their chemotherapy. Success in eradicating vitreous seeds was 100%; overall salvage rate was 67%. Anterior toxicity was observed in 2 out of 6 eyes and posterior toxicity in 4 out of 6 eyes. Conclusion: The concurrent chemoreduction and IVM protocol demonstrated a similar efficacy of globe salvage while sparing children additional EUAs. However, the increased rates of observed melphalan-related toxicities for concurrent therapy are concerning. Further clinical experience is necessary to define the best initiation time and dosing schedule for IVM.

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Section: Discussionmentioning

confidence: 95%

Integrated Treatment during the Intravitreal Melphalan Era: Concurrent Intravitreal Melphalan and Systemic Chemoreduction

et al. 2018

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“…Recently, Suzuki et al [8] described their 21-year experience with intravitreal melphalan injections for vitreous seeding in retinoblastoma. They reported on 2 cases of diffuse chorioretinal atrophy associated with intravitreal melphalan injections.…”

Section: Discussionmentioning

confidence: 99%

Acute Hemorrhagic Retinopathy following Intravitreal Melphalan Injection for Retinoblastoma: A Report of Two Cases and Technical Modifications to Enhance the Prevention of Retinal Toxicity

et al. 2016

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Aims: To report the occurrence of acute hemorrhagic retinopathy following intravitreal melphalan injection for retinoblastoma. Methods: This is a retrospective case series of 2 patients with retinoblastoma treated with intravitreal melphalan for vitreous seeding who developed acute hemorrhagic retinopathy. Results: Patient 1 is a 6-month-old female with bilateral retinoblastoma (Group D right eye and Group B left eye) treated with 4 cycles of systemic chemotherapy and 2 intravitreal melphalan injections in each eye. Patient 2 is a 10-month-old male with unilateral Group D retinoblastoma treated with 6 cycles of systemic chemotherapy and 2 injections of intravitreal melphalan. At the 1-week follow-up after the second injection, both patients had an acute hemorrhagic retinopathy that resulted in chorioretinal toxicity with a sharp demarcation line between the normal and abnormal retina. At the last follow-up (22 and 12 months, respectively), there was total tumor control and resolution of vitreous seeding in both patients. Conclusions: Although intravitreal melphalan injection is effective for vitreous seeding in eyes with retinoblastoma, acute hemorrhagic retinopathy and diffuse chorioretinal atrophy is a possible complication of this treatment modality. Given the clinical findings observed in these patients, the development of this retinal toxicity most likely results from a retrohyaloid overdose. Consequently we suggest preventive measures aimed at limiting the risk of retrohyaloid injection.

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“…Finally, while scleral thinning following bevacizumab has been visualized with OCT 9 , it seldom involves a rarity of scleral tissue with visualization of the underlying uvea as was seen in our case. It is possible that the melphalan contributed to atrophy/necrosis of the ocular surface, in a similar manner that has been found with the iris, choroid, RPE and retina 1,4,14,15 . On the other hand, the scleral pigmentation may simply represent migrated deposition of released pigments from nearby retina, ciliary body or iris.…”

Section: Discussionmentioning

confidence: 55%

Anterior Ocular Toxicity of Intravitreous Melphalan for Retinoblastoma

2015

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ntravitreous injection of melphalan hydrochloride is an effective means of treating vitreous seeding for retinoblastoma, and this technique now saves many eyes that once would have been enucleated. [1][2][3] However, each intravitreous injection of melphalan results in a decrement of approximately 5% in retinal function as measured by electroretinography. 4 Other groups 3,5-7 have confirmed the toxic effects of intravitreous melphalan on the posterior segment of the eye. In this report, we discuss what we believe to be the previously unrecognized topic of anterior segment toxic effects on the eye following intravitreous administration of melphalan. These findings are particularly pertinent since more groups are using this treatment technique.All injections were performed using a 33-gauge, ½-inch needle with a tribeveled point and siliconized shaft. The institutional review board of Memorial Sloan Kettering Cancer Center approved this study. Written informed consent had been obtained from all parents, and the institutional review board of Memorial Sloan Kettering Cancer Center provided a waiver for this retrospective study.

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Intravitreal injection of melphalan for intraocular retinoblastoma

Cited by 68 publications

References 22 publications

Integrated Treatment during the Intravitreal Melphalan Era: Concurrent Intravitreal Melphalan and Systemic Chemoreduction

Integrated Treatment during the Intravitreal Melphalan Era: Concurrent Intravitreal Melphalan and Systemic Chemoreduction

Acute Hemorrhagic Retinopathy following Intravitreal Melphalan Injection for Retinoblastoma: A Report of Two Cases and Technical Modifications to Enhance the Prevention of Retinal Toxicity

Anterior Ocular Toxicity of Intravitreous Melphalan for Retinoblastoma

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