July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Ophthalmic Vascular Events following Primary Intra-arterial Chemotherapy for Retinoblastoma
Analysis of 243 infusions of 76 eyes at a single center
Author Affiliations & Notes
  • Lauren A Dalvin
    Wills Eye Hospital, Philadelphia, Pennsylvania, United States
    Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States
  • David Ancona-Lazama
    Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • J. Antonio Lucio-Alvarez
    Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Pascal Jabbour
    Thomas Jefferson University, Philadelphia, Pennsylvania, United States
  • Carol L Shields
    Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Footnotes
    Commercial Relationships   Lauren Dalvin, Eye Tumor Research Foundation (F), Heed Ophthalmic Foundation (F); David Ancona-Lazama, None; J. Lucio-Alvarez, None; Pascal Jabbour, None; Carol Shields, Eye Tumor Research Foundation (F)
  • Footnotes
    Support  Heed Ophthalmic Foundation, Eye Tumor Research Foundation
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 1646. doi:
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    • Get Citation

      Lauren A Dalvin, David Ancona-Lazama, J. Antonio Lucio-Alvarez, Pascal Jabbour, Carol L Shields; Ophthalmic Vascular Events following Primary Intra-arterial Chemotherapy for Retinoblastoma
      Analysis of 243 infusions of 76 eyes at a single center. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1646.

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

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Abstract

Purpose : Intra-arterial chemotherapy (IAC) has an essential role in retinoblastoma (Rb) management. Direct delivery of chemotherapy into the ophthalmic artery (OA) can produce vascular side effects, but risk factors for such events are not fully understood. We performed a retrospective, observational clinical study to review ophthalmic vascular events following IAC for Rb.

Methods : Patients who received unilateral IAC as primary treatment for Rb in January 2009-November 2017 at a single institution were included. Records were reviewed for tumor features, IAC dosage, number of cycles, dates of administration and ophthalmic vascular events. Patient characteristics and vascular event rates in the early IAC era (2009-2011) versus more recent years (2012-2017) were compared using t-test and Fisher’s exact test.

Results : There were 76 patients treated with IAC during the timeline, divided into early (22 eyes, 57 infusions) and recent (54 eyes, 186 infusions) eras. IAC consisted of melphalan (243 infusions), topotecan (124 infusions) and carboplatin (9 infusions). A comparison (early vs. recent era) revealed fewer mean number of infusions (2.6 vs. 3.4 p=0.02). Mean patient age (24 vs. 29 months, p=0.05), International Classification of Retinoblastoma group (p=0.12), largest tumor diameter (19 vs. 18mm, p=0.49), tumor thickness (10 vs. 10mm, p=0.87), vitreous seed presence (50% vs 54%, p=0.92), subretinal seed presence (45% vs. 54%, p=0.35) or retinal detachment (64% vs. 78%, p=0.12) did not differ. A comparison of vascular events following IAC included OA occlusion (6 vs. 0, p<0.001), choroidal ischemia (3 vs. 2, p=0.14), vitreous hemorrhage (2 vs. 1, p=0.20), peripheral retinal nonperfusion (1 vs. 1, p=0.50), branch retinal vein occlusion (1 vs. 0, p=0.29) and subretinal hemorrhage (0 vs. 1, p=0.99). All 4 patients treated with carboplatin had an event. Event rates did not correlate to dosage of melphalan/topotecan or tumor size. Total number of ophthalmic vascular events (early era vs. recent era) were significantly fewer in the recent era (59% vs. 9% per eye, 23% vs. 3% per infusion, p<0.001). No IAC-induced vascular event occurred in 21 consecutive eyes treated in 2016-2017.

Conclusions : Ophthalmic vascular events following IAC have decreased over time. Experience performing IAC could be an important factor predicting IAC-related vascular events.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

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