June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
A comparison of retinoblastoma vitreous seed clouds (class 3) treated with ophthalmic artery chemosurgery with or without intravitreous chemotherapy
Author Affiliations & Notes
  • Jasmine H Francis
    Ophthalmic Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, United States
    Weill Cornell Medical Center, New York, New York, United States
  • Saipriya Iyer
    Ophthalmic Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Pierre Gobin
    Weill Cornell Medical Center, New York, New York, United States
  • Brian Marr
    Ophthalmic Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, United States
    Weill Cornell Medical Center, New York, New York, United States
  • Scott E Brodie
    Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • David H Abramson
    Ophthalmic Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, United States
    Weill Cornell Medical Center, New York, New York, United States
  • Footnotes
    Commercial Relationships   Jasmine Francis, None; Saipriya Iyer, None; Pierre Gobin, None; Brian Marr, None; Scott Brodie, None; David Abramson, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 3340. doi:
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      Jasmine H Francis, Saipriya Iyer, Pierre Gobin, Brian Marr, Scott E Brodie, David H Abramson; A comparison of retinoblastoma vitreous seed clouds (class 3) treated with ophthalmic artery chemosurgery with or without intravitreous chemotherapy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3340.

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

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Abstract

Purpose : Class 3 retinoblastoma vitreous seeds, or clouds, have the distinctive clinical profile because they occur more commonly in older patients with unilateral disease and peripheral tumors. They receive the highest amount of intravitreous melphalan and take the longest time to regress. This study compares efficacy and toxicity of treatment between ophthalmic artery chemosurgery with or without intravitreous chemotherapy.

Methods : 40 eyes containing clouds (class 3 vitreous seeds) of 40 retinoblastoma patients (19 treated with OAC alone and 21 treated with OAC and intravitreous (OAC/IVit) were investigated. The outcomes measures of ocular survival, disease-free survival and time to regression of seeds were analyzed with Kaplan-Meier estimates. Ocular toxicity was evaluated by clinical findings and electroretinography (ERG): 30 Hz flicker responses were recorded at baseline, immediately prior to each injection and at each follow-up visit. Continuous variables (age, follow-up time) were compared with a Students’ t-test and categorical variables (laterality, disease status, etc) were compared with Fisher’s Exact Test.

Results : There were no disease or treatment-related deaths and no metastatic disease. No patient developed externalization of tumor. There was no significant difference in the age, laterality or disease and disease status (naïve vs prior treated) between the two groups. The time to regression was significantly shorter for eyes treated with OAC/IVit (5.6mos), compared to eyes treated with OAC alone (14.6 mos, p<0.001). The 18-month Kaplan-Meier estimates of disease-free survival were significantly worse for the OAC alone group: 67.1% (95%CI 40.9-83.6), compared to the OAC/IVit group: 94.1% (95%CI 65-99.1), (p=0.05). The 36-month Kaplan-Meier estimate of ocular survival 83.3% (95%CI 56.7-94.3) for the OAC alone and 100% for the OAC/IVit, p=0.16. Changes in electroretinogram responses were not significantly different between the two groups.

Conclusions : Treating vitreous seed clouds with OAC and intravitreous chemotherapy, compared to OAC alone, results in a shorter time to regression and is associated with fewer recurrences requiring additional treatment. The toxicity to the retina appears to be equivalent between the two groups.

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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