title: Indocyanine Green-Enhanced Transpupillary Thermotherapy for Retinoblastoma: Analysis of 42 Tumors.
abstract: OBJECTIVE
  To evaluate the efficacy of indocyanine green-enhanced transpupillary thermotherapy (ICG-TTT) for retinoblastoma that shows suboptimal response to conventional treatments.
  
  
  METHODS
  A single center, retrospective chart review. The technique involved ICG infusion (range: 0.3 to 0.5 mg/kg) 1 minute prior to applying TTT using the indirect ophthalmoscope technique with a spot size of 1.2 mm.
  
  
  RESULTS
  There were 42 retinoblastomas in 30 eyes of 21 patients treated with ICG-TTT. The reasons for ICG enhancement included suboptimal response to standard TTT (n = 31, 74%), recurrence after standard TTT (n = 3, 7%), or minimally pigmented fundus with poor standard TTT uptake (n = 8, 19%). The mean patient age at treatment was 12 months (median: 11.6 months, range: 3 to 31 months). The mean tumor base was 3.5 mm (median: 3 mm), mean tumor thickness was 2.5 mm (median; 2 mm), mean distance to the foveola was 2.6 mm (median: 3 mm), and mean distance to the optic disc was 2.2 mm (median: 0.75 mm). Treatment parameters included a spot size of 1.2 mm, mean power of 760 mW (median: 800 mW, range: 400 to 1,200 mW), and mean duration of 4 minutes (median: 4 minutes, range: 0.5 to 14 minutes). Following a median of 2 sessions (range: 1 to 5 sessions) of ICG-TTT, 33 (79%) tumors demonstrated complete regression. The mean tumor thickness postoperatively was 1.7 mm. Two (5%) tumors showed minimal regression after ICG-TTT. During a mean follow-up of 46 months (median: 33 months), tumor recurrence after ICG-TTT developed in 7 (17%) cases at a mean interval of 7 months. Local complications of ICG-TTT included focal paraxial cataract (n = 2, 7%), iris atrophy (n = 1, 3%), and transient retinal hemorrhage (n = 2, 7%). Systemic problems included ICG allergy (n = 1, 5%). Overall, tumor control and globe salvage was achieved in all 30 (100%) eyes. There were no metastatic events.
  
  
  CONCLUSIONS
  ICG-TTT is an effective alternative for reti-noblastoma control, particularly for small tumors that show suboptimal response to standard
authors.forename: Murat
authors.initials: M
authors.lastname: Hasanreisoglu
authors.forename: Jarin
authors.initials: J
authors.lastname: Saktanasate
authors.forename: Rachel
authors.initials: R
authors.lastname: Schwendeman
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Shields
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
mesh_terms: D002675:Child, Preschool; D004396:Coloring Agents / Q000008:administration & dosage*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007208:Indocyanine Green / Q000008:administration & dosage*; D007223:Infant; D054023:Lasers, Semiconductor; D008297:Male; D011680:Pupil; D019572:Retinal Neoplasms / Q000473:pathology / Q000628:therapy*; D012175:Retinoblastoma / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green