title: Fluorescein angiographic findings after intra-arterial chemotherapy for retinoblastoma.
abstract: OBJECTIVE
  To evaluate fluorescein angiography (FA) findings after intra-arterial chemotherapy (IAC) for retinoblastoma.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Twenty-four eyes of 24 patients.
  
  
  METHODS
  Fifty-five IAC procedures for delivery of melphalan 5 mg and possible carboplatin 30 mg.
  
  
  METHODS
  Vascular flow of iris, retina, and choroid after IAC.
  
  
  RESULTS
  All patients received melphalan 5 mg, whereas the first 6 patients also were treated with additional carboplatin 30 mg. The IAC was performed as primary treatment in 17 eyes and as secondary treatment (after systemic chemotherapy) in 7 eyes. Two patients also received external-beam radiotherapy before IAC. At presentation, FA revealed neovascularization of the iris (NVI) in 8 eyes, and after IAC, complete NVI regression was noted in 5 eyes (63%). After a mean follow-up of 13 months after IAC, FA depicted the main tumor with decreased fluorescence in 22 eyes (92%). After 55 ophthalmic artery catheterizations, retinal vascular abnormalities by FA were detected in 7 eyes (13%) and choroidal vascular abnormalities were detected in 6 eyes (11%). The retinal abnormalities included ophthalmic artery obstruction (n = 1), transient ophthalmic artery spasm (n = 1), central retinal artery obstruction (n = 1), branch retinal artery obstruction (n = 2), and peripheral retinal ischemia (n = 2). Additional retinal neovascularization was found in 1 patient. The choroidal abnormalities included sector (n = 5) or diffuse (n = 1) choroidal nonperfusion. New-onset iris neovascularization was found in 2 patients. Retinal vascular abnormalities were diagnosed after median of 1 month after the first IAC, whereas choroidal vascular abnormalities were found after median of 5 months after the first IAC.
  
  
  CONCLUSIONS
  Fluorescein angiography suggests that vascular perfusion to the retina and the choroid can be compromised after IAC for retinoblastoma. The most common vascular abnormality was choroidal sector or diffuse nonperfusion.
authors.affiliation: Ocular Oncology Service, Suite 1440, Wills Eye Institute, 840 Walnut Street, Philadelphia, PA 19107, USA. carol.shields@shieldsoncology.com
authors.forename: Carlos
authors.initials: C
authors.lastname: Bianciotto
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
authors.forename: Juan C
authors.initials: JC
authors.lastname: Iturralde
authors.forename: Ahmet
authors.initials: A
authors.lastname: Sarici
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Shields
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D016190:Carboplatin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D020256:Choroidal Neovascularization / Q000139:chemically induced / Q000175:diagnosis; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007261:Infusions, Intra-Arterial; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D009880:Ophthalmic Artery; D018714:Radiotherapy, Adjuvant; D019572:Retinal Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D015861:Retinal Neovascularization / Q000139:chemically induced / Q000175:diagnosis; D012171:Retinal Vessels / Q000187:drug effects; D012175:Retinoblastoma / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D016190:Carboplatin; D008558:Melphalan