title: The classification of vitreous seeds in retinoblastoma and response to intravitreal melphalan.
abstract: OBJECTIVE
  To evaluate the clinical characteristics of the 3 classifications of vitreous seeds in retinoblastoma-dust (class 1), spheres (class 2), and clouds (class 3)-and their responses to intravitreal melphalan.
  
  
  METHODS
  Retrospective, bi-institutional cohort study.
  
  
  METHODS
  A total of 87 patient eyes received 475 intravitreal injections of melphalan (median dose, 30 μg) given weekly, a median of 5 times (range, 1-12 times).
  
  
  METHODS
  At presentation, the vitreous seeds were classified into 3 groups: dust, spheres, and clouds. Indirect ophthalmoscopy, fundus photography, ultrasonography, and ultrasonic biomicroscopy were used to evaluate clinical response to weekly intravitreal melphalan injections and time to regression of vitreous seeds. Kaplan-Meier estimates of time to regression and ocular survival, patient survival, and event-free survival (EFS) were calculated and then compared using the Mantel-Cox test of curve.
  
  
  METHODS
  Time to regression of vitreous seeds, patient survival, ocular survival, and EFS.
  
  
  RESULTS
  The difference in time to regression was significantly different for the 3 seed classes (P < 0.0001): the median time to regression was 0.6, 1.7, and 7.7 months for dust, spheres, and clouds, respectively. Eyes with dust received significantly fewer injections and a lower median and cumulative dose of melphalan, whereas eyes with clouds received significantly more injections and a higher median and cumulative dose of melphalan. Overall, the 2-year Kaplan-Meier estimates for ocular survival, patient survival, and EFS (related to target seeds) were 90.4% (95% confidence interval [CI], 79.7-95.6), 100%, and 98.5% (95% CI, 90-99.7), respectively.
  
  
  CONCLUSIONS
  The regression and response of vitreous seeds to intravitreal melphalan are different for each seed classification. The vitreous seed classification can be predictive of time to regression, number, median dose, and cumulative dose of intravitreal melphalan injections required.
authors: Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York; Weill-Cornell Medical Center, New York, New York. Electronic address: francij1@mskcc.org.
authors: Jasmine H
authors: JH
authors: Francis
authors: Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York; Weill-Cornell Medical Center, New York, New York.
authors: David H
authors: DH
authors: Abramson
authors: Jules-Gonin Eye Hospital, Lausanne, Switzerland.
authors: Marie-Claire
authors: MC
authors: Gaillard
authors: Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York; Weill-Cornell Medical Center, New York, New York.
authors: Brian P
authors: BP
authors: Marr
authors: Pediatric Hematology Oncology Unit, University Hospital CHUV, Lausanne, Switzerland.
authors: Maja
authors: M
authors: Beck-Popovic
authors: Jules-Gonin Eye Hospital, Lausanne, Switzerland.
authors: Francis L
authors: FL
authors: Munier
mesh_terms: D000293:Adolescent; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018572:Disease-Free Survival; D005134:Eye Neoplasms / Q000145:classification* / Q000188:drug therapy / Q000556:secondary; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D058449:Intravitreal Injections; D008558:Melphalan / Q000008:administration & dosage* / Q000627:therapeutic use; D009366:Neoplasm Seeding; D019572:Retinal Neoplasms / Q000145:classification* / Q000188:drug therapy / Q000473:pathology; D012175:Retinoblastoma / Q000145:classification* / Q000188:drug therapy / Q000556:secondary; D012189:Retrospective Studies; D015996:Survival Rate; D014822:Vitreous Body / Q000187:drug effects* / Q000473:pathology*
chemical_list: D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan