title: Intra-arterial chemotherapy for retinoblastoma: report No. 2, treatment complications.
abstract: OBJECTIVE
  To describe treatment complications following intra-arterial chemotherapy (IAC) for retinoblastoma.
  
  
  METHODS
  A retrospective interventional series of ophthalmic artery cannulation for IAC injection (3 planned sessions at 1-month intervals) was undertaken. Thirty-eight catheterizations of 17 eyes of 17 patients were performed from September 2008 to September 2010. Fluoroscopy of the ophthalmic artery was performed before and immediately after treatment. Heparin was given during the procedure and aspirin (40 mg) was given orally for 1 week. The treatment complications were determined.
  
  
  RESULTS
  Only 17 of 190 children were selected for treatment with IAC during this period. Following successful ophthalmic artery cannulation in 16 cases, there was no evidence of metastasis, stroke, brain injury, or persistent systemic toxic effects. Fluoroscopy demonstrated patent ophthalmic artery immediately before and after IAC injection in each case. Following therapy, orbital and adnexal findings at 1 month included eyelid edema (n = 13), blepharoptosis (n = 10), cilia loss (n = 1), and orbital congestion with temporary dysmotility (n = 12). These findings resolved within 6 months in all cases. Following therapy, vascular findings included ophthalmic artery stenosis (permanent in 3 cases, temporary in 1 case), confirmed on fluoroscopy in 3 cases. Concomitant central or branch retinal artery occlusion was noted (permanent in 2 cases, temporary in 1 case). Subtle retinal pigment epithelial mottling in 9 cases that slowly evolved to later-onset underlying choroidal atrophy in 5 cases was noted.
  
  
  CONCLUSIONS
  Treatment with IAC for retinoblastoma can lead to mild and severe short-term ocular complications, including eyelid edema as well as potentially blinding vascular obstruction. This procedure should be used with caution.
authors.affiliation: Ocular Oncology Service, Wills Eye Institute, Philadelphia, PA 19107, USA. carol.shields@shieldsoncology.com
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Bianciotto
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Griffin
authors.forename: Aparna
authors.initials: A
authors.lastname: Ramasubramanian
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenwasser
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Shields
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D001763:Blepharoptosis / Q000209:etiology; D002404:Catheterization; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004487:Edema / Q000209:etiology; D005141:Eyelid Diseases / Q000209:etiology; D005260:Female; D005451:Fluorescein Angiography; D005471:Fluoroscopy; D006801:Humans; D007223:Infant; D007269:Injections, Intra-Arterial / Q000009:adverse effects*; D008297:Male; D008558:Melphalan / Q000008:administration & dosage*; D015835:Ocular Motility Disorders / Q000209:etiology; D009880:Ophthalmic Artery / Q000000981:diagnostic imaging; D019572:Retinal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D012175:Retinoblastoma / Q000188:drug therapy* / Q000556:secondary; D012189:Retrospective Studies
chemical_list: D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan