title: Ophthalmic artery chemosurgery for the management of retinoblastoma in eyes with extensive (>50%) retinal detachment.
abstract: BACKGROUND
  Superselective delivery of chemotherapy through the ophthalmic artery, i.e. ophthalmic artery chemosurgery, has been used for the treatment of advanced intraocular retinoblastoma. Herein, we evaluate the efficacy of ophthalmic artery chemosurgery for retinoblastoma associated with >50% retinal detachment.
  
  
  METHODS
  Retrospective review of 37 eyes of 34 retinoblastoma patients who had extensive (>50%) bullous non-rhegmatogenous retinal detachments and received ophthalmic artery chemosurgery either as primary treatment or as "salvage" treatment after failed multi-cycle intravenous chemotherapy and/or external beam radiation (mean follow-up, 21 months). Data on patient and ocular survival, complications of ophthalmic artery chemosurgery treatments, time course of retinal reattachment, and serial electroretinograms (ERG) were collected.
  
  
  RESULTS
  A total of 134 ophthalmic artery chemosurgery injections were performed. All children survive. Five eyes (5/37; 14%) were enucleated for progression of disease. The Kaplan-Meier enucleation-free survival rate at 2 years was 87.9% (95% confidence interval, 76.5-99.3%). The retina reattached in 28 eyes (28/37; 76%) and the 30-Hz flicker ERGs improved by >25 µV in seven eyes (7/37; 19%), remained stable (change < 25 µV) in 26 eyes (26/37; 70%), and decreased by >25 µV in four eyes (4/37; 11%). The Kaplan-Meier retinal reattachment rate was 58% after 3 months and three ophthalmic artery chemosurgery infusions (95% confidence interval, 41.9-74.1%).
  
  
  CONCLUSIONS
  Ophthalmic artery chemosurgery is effective in preventing enucleation, promoting retinal reattachment and preserving or improving retinal function in the majority of eyes with advanced retinoblastoma and >50% retinal detachment that would otherwise be considered for enucleation.
authors.affiliation: Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
authors.forename: Sotiria
authors.initials: S
authors.lastname: Palioura
authors.forename: Y Pierre
authors.initials: YP
authors.lastname: Gobin
authors.forename: Scott E
authors.initials: SE
authors.lastname: Brodie
authors.forename: Brian P
authors.initials: BP
authors.lastname: Marr
authors.forename: Ira J
authors.initials: IJ
authors.lastname: Dunkel
authors.forename: David H
authors.initials: DH
authors.lastname: Abramson
mesh_terms: D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009880:Ophthalmic Artery / Q000601:surgery; D013508:Ophthalmologic Surgical Procedures; D012163:Retinal Detachment / Q000150:complications / Q000401:mortality / Q000628:therapy; D012175:Retinoblastoma / Q000150:complications / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate