title: Ischemic necrosis and atrophy of the optic nerve after periocular carboplatin injection for intraocular retinoblastoma.
abstract: OBJECTIVE
  To report four cases of optic nerve neuropathy in three children treated with periocular carboplatin injections for unilateral or bilateral intraocular retinoblastoma.
  
  
  METHODS
  Retrospective, observational case series.
  
  
  METHODS
  
  
  
  METHODS
  University-based Ophthalmology Practice.
  
  
  METHODS
  Four eyes of three children with retinoblastoma enucleated after nonsuccessful multimodality treatment including periocular carboplatin injections.
  
  
  METHODS
  The enucleated eyes were routinely processed and evaluated by light microscopy. A retrospective chart review of all four cases was performed.
  
  
  RESULTS
  Three enucleated eyes (Reese-Ellsworth groups III and VB) were obtained from two children with bilateral multifocal retinoblastoma, and one eye (Reese-Ellsworth group IIB) was harvested from a child with unilateral retinoblastoma. All affected eyes underwent three to seven periocular carboplatin injections before enucleation. Additional treatment modalities included systemic chemotherapy, transpupillary thermotherapy, transscleral cryotherapy, and external beam radiotherapy. Histopathologic evaluation of the enucleated eyes revealed focal areas of ischemic necrosis or atrophy of the optic nerve along with dystrophic calcification and mild inflammation in the surrounding fibrovascular adipose tissue.
  
  
  CONCLUSIONS
  Periocular injections of carboplatin may be a useful treatment approach in the management of patients with advanced intraocular retinoblastoma and may minimize systemic side-effects. However, ophthalmologists and pediatric oncologists should be aware of potential marked local complications with periocular carboplatin delivery, including ischemic optic neuropathy. Modifying the injection site/location (for example, subtenon space) or adding other delivery routes adjuncts (for example, fibrin sealant) deserves further study.
authors.affiliation: Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia 30322, USA. ischmac@emory.edu
authors.forename: Ingo
authors.initials: I
authors.lastname: Schmack
authors.forename: G Baker
authors.initials: GB
authors.lastname: Hubbard
authors.forename: Shin J
authors.initials: SJ
authors.lastname: Kang
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Aaberg
authors.forename: Hans E
authors.initials: HE
authors.lastname: Grossniklaus
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D001284:Atrophy / Q000139:chemically induced; D016190:Carboplatin / Q000009:adverse effects*; D003131:Combined Modality Therapy; D015353:Eye Enucleation; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007267:Injections; D008297:Male; D009336:Necrosis / Q000139:chemically induced; D009900:Optic Nerve / Q000473:pathology; D018917:Optic Neuropathy, Ischemic / Q000139:chemically induced*; D009915:Orbit; D019572:Retinal Neoplasms / Q000188:drug therapy*; D012175:Retinoblastoma / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin