June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Anti-VEGF therapy for secondary neovascularization following intra-arterial chemotherapy for advanced retinoblastoma
Author Affiliations & Notes
  • Francis L Munier
    Ophthalmology Department, Jules-Gonin Eye Hospital, Lausanne, Switzerland
  • Marie-Claire Gaillard
    Ophthalmology Department, Jules-Gonin Eye Hospital, Lausanne, Switzerland
  • Francesco Puccinelli
    Neuroradiology Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Vaud, Switzerland
  • Ciara Bergin
    Ophthalmology Department, Jules-Gonin Eye Hospital, Lausanne, Switzerland
  • Susan Houghton
    Ophthalmology Department, Jules-Gonin Eye Hospital, Lausanne, Switzerland
  • Alexandre Moulin
    Ophthalmology Department, Jules-Gonin Eye Hospital, Lausanne, Switzerland
  • Maja Beck-Popovic
    Pediatric Hematology Oncology Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Vaud, Switzerland
  • Footnotes
    Commercial Relationships   Francis Munier, None; Marie-Claire Gaillard, None; Francesco Puccinelli, None; Ciara Bergin, None; Susan Houghton, None; Alexandre Moulin, None; Maja Beck-Popovic, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 3338. doi:
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      Francis L Munier, Marie-Claire Gaillard, Francesco Puccinelli, Ciara Bergin, Susan Houghton, Alexandre Moulin, Maja Beck-Popovic; Anti-VEGF therapy for secondary neovascularization following intra-arterial chemotherapy for advanced retinoblastoma. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3338.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Primary neovascularization in retinoblastoma is still considered an indication for enucleation (Group E), as well as in secondary cases, habitually related to radiotherapy. We investigated the use of anti-VEGF therapy in secondary vasoproliferative disease for globe salvage after intra-arterial chemotherapy (IAC).

Methods : Retrospective review of consecutive retinoblastoma patients with progression of proliferative retinopathy and/or rubeosis despite cryo-photo-ablation of the ischemic retina, or inability to perform cryo-ablation due to hematovitreous and/or retinal detachment. Anterior and posterior segment status was monitored under anesthesia by photography and fluorescein angiography, and intravitreal anti-VEGF (ranibizumab and/or aflibercept) administered according to the safety-enhanced technique.

Results : From November 2010 to May 2016, 24 patients (26 eyes) with advanced retinoblastoma complied with the inclusion criteria, having received IAC and developed secondary neovascularization. Three eyes received IAC only; 23/26 underwent prior systemic chemotherapy (IVC) with/without radiotherapy (6/17 respectively). Anti-VEGF was administered at a mean interval of 6.4 (median 2.5) months after IAC.
Vasoproliferative complications were classified as: rubeosis with/without localized retinal neovascularization or extended fibrovascular membrane. A total of 46 injections were administered, a single injection for 13 eyes (50%), multiple injections for 13 eyes (50%). 9/26 eyes (34.6%) were ultimately enucleated: 6 for progressive disease.Three had intermediate histopathologic risk factors and received adjuvant IVC. Mean follow-up for globe salvage was 19.4 months. All patients are alive without metastases.

Conclusions : IAC is identified as a novel risk factor for secondary neovascularization related to ischemic retinopathy with/without retinal detachment. In our series, anti-VEGF enabled 23 (63.8%) eyes to be salvaged, by providing the conditions to continue conservative treatment i.e. angiography-directed therapy of any ischemic retinopathy; subsequent retinal detachment surgery as necessary, and continued tumor-related management.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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