Anterior segment complications and globe salvage following intravitreal or periocular chemotherapy for intraocular retinoblastoma

Abstract

Purpose : To report the incidence of anterior segment complications and associated risk of enucleation among retinoblastoma patients treated at St Jude Children's Research Hospital (SJCRH) with Intravitreal (IVit) or sub-Tenon’s (ST) chemotherapy.

Methods : This was a retrospective, non-interventional analysis. Patients were included if: 1) had opaque media with poor visualization of the posterior pole or required refractive correction; 2) history of IVit or ST chemotherapy to save a single eye in bilateral disease or eyes with visual potential in unilateral or bilateral disease; 4) previously received systemic treatment. The doses used were: IVit Melphalan (20micrograms/0.1ml), ST Carboplatin (20mg/2ml) or ST Topotecan (2mg/2ml). The qualitative variables were compared using Pearson's Chi-square test (χ2) and likelihood ratios. The significance level was set at p≤0.05 (*).

Results : 85 eyes in 71 patients were included, of which 48 had bilateral disease. Patients were divided by type of drug(s) received (fig 1). Prevalence of anterior segment complications include cataract in 23.5%, posterior synechiae in 5.9%, iris atrophy in 1.2% and persistent conjunctivitis in 2.4%. Conjunctivitis was present in 1 eye following 3 doses of ST carboplatin and 4 doses of IVit Melphalan, and in a second eye after 4 doses of ST carboplatin. Sixty-five percent of patients with cataract underwent cataract surgery. 40% of eyes were enucleated (N=34): 58.8% from group 1, 2.9% group 2, 0% group 3, 29.4% group 4, 2.9% group 5, and 5.9% group 6. Enucleation rate was not significantly different among patients with cataract or who had undergone cataract surgery. Melphalan was the only drug associated to significant higher rate in enucleations (fig 2). Globe salvage was achieved in 60% of eyes.

Conclusions : No identifiable correlation was observed between the incidence of anterior segment complications and enucleation rates in patients treated with periocular or intravitreal chemotherapy for retinoblastoma.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.