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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)
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).
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.
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.
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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