title: Occurrence of sectoral choroidal occlusive vasculopathy and retinal arteriolar embolization after superselective ophthalmic artery chemotherapy for advanced intraocular retinoblastoma.
abstract: BACKGROUND
  Superselective ophthalmic artery chemotherapy (SOAC) has recently been proposed as an alternative to intravenous chemoreduction for advanced intraocular retinoblastoma. Preliminary results appear promising in terms of tumor control and eye conservation, but little is known regarding ocular toxicity and visual prognosis. In this study, we report on the vascular adverse effects observed in our initial cohort of 13 patients.
  
  
  METHODS
  The charts of 13 consecutive patients with retinoblastoma who received a total of 30 injections (up to 3 injections of a single agent per patient at 3-week interval) of melphalan (0.35 mg/kg) in the ophthalmic artery between November 2008 and June 2010 were retrospectively reviewed. RetCam fundus photography and fluorescein angiography were performed at presentation and before each injection. Vision was assessed at the latest visit.
  
  
  RESULTS
  Enucleation and external beam radiotherapy could be avoided in all cases but one, with a mean follow-up of 7 months. Sectoral choroidal occlusive vasculopathy leading to chorioretinal atrophy was observed temporally in 2 eyes (15%) 3 weeks to 6 weeks after the beginning of SOAC and retinal arteriolar emboli in 1 eye 2 weeks after injection. There was no stroke or other clinically significant systemic side effects except a perioperative transient spasm of the internal carotid artery in one patient. Vision ranged between 20/1600 and 20/32 depending on the status of the macula.
  
  
  CONCLUSIONS
  Superselective ophthalmic artery chemotherapy was effective in all patients with no stroke or other systemic vascular complications. Unlike intravenous chemoreduction, SOAC is associated with potentially sight-threatening adverse effects, such as severe chorioretinal atrophy secondary to subacute choroidal occlusive vasculopathy or central retinal artery embolism, not to mention the risk of ophthalmic artery obstruction, which was not observed in this series. Further analysis of the risks and benefits of SOAC will define its role within the therapeutic arsenal. Meanwhile, we suggest that SOAC should be given in one eye only and restricted to advanced cases of retinoblastoma, as an alternative to enucleation and/or external beam radiotherapy.
authors.affiliation: Jules Gonin Eye Hospital, Lausanne, Switzerland. francis.munier@fa2.ch
authors.forename: Francis L
authors.initials: FL
authors.lastname: Munier
authors.forename: Maja
authors.initials: M
authors.lastname: Beck-Popovic
authors.forename: Aubin
authors.initials: A
authors.lastname: Balmer
authors.forename: Marie-Claire
authors.initials: MC
authors.lastname: Gaillard
authors.forename: Etienne
authors.initials: E
authors.lastname: Bovey
authors.forename: Stefano
authors.initials: S
authors.lastname: Binaghi
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000009:adverse effects*; D001284:Atrophy; D010478:Chemotherapy, Cancer, Regional Perfusion; D002675:Child, Preschool; D002829:Choroid / Q000098:blood supply / Q000473:pathology; D015862:Choroid Diseases / Q000139:chemically induced* / Q000175:diagnosis; D005451:Fluorescein Angiography; D006801:Humans; D007223:Infant; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects*; D009880:Ophthalmic Artery; D010781:Photography; D015356:Retinal Artery Occlusion / Q000139:chemically induced* / Q000175:diagnosis; D019572:Retinal Neoplasms / Q000188:drug therapy*; D012175:Retinoblastoma / Q000188:drug therapy*; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology
chemical_list: D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan