Bilateral orbital vasculature alterations after systemic chemotherapy and external beam radiation therapy treatment of advanced retinoblastoma: implications for intraarterial chemotherapy management.
OBJECTIVE
The purpose of this study was to report significant alterations in orbital vasculature after combined systemic chemoreduction with consolidating external beam radiotherapy treatment in a case of advanced retinoblastoma and to discuss implications for intraarterial melphalan rescue chemotherapy.


METHODS
We studied the case of a 22-month-old child who had been treated recently with intraarterial melphalan perfusion after multimodal therapy for advanced intraocular retinoblastoma.


RESULTS
Orbital angiography of both eyes, performed before the intraarterial melphalan injection, documented an atypical attenuated orbital vasculature. The right ophthalmic artery angiogram showed loss of a normal dominant central retinal artery. Instead, multiple dysplastic angiogenic vessels from the ophthalmic artery were found to supply the retina. A single long ciliary artery was noted with collateral vessels supplying the anterior globe. The left ophthalmic artery angiogram showed a stenotic artery with minimal anterograde flow.


CONCLUSIONS
Orbital vasculature may be impacted by combined systemic chemotherapy and external beam radiation therapy. These changes need to be considered in the use of intraarterial melphalan for the treatment of patients with advanced retinoblastoma.
From the *Department of Ophthalmology, Bascom Palmer Eye Institute; †Department of Neurosurgery; and ‡Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida.
Hinda
H
Boutrid
Stacey Quintero
SQ
Wolfe
Timothy G
TG
Murray
Yolanda
Y
Pina
Roham
R
Moftakhar
Cristina E
CE
Fernandes
Jennifer
J
Reichbach
Mohammad Ali
MA
Aziz-Sultan