Mulvihill Alan, Budning Andrew, Jay Venita, Vandenhoven Cynthia, Heon Elise, Gallie Brenda L, Chan Helen S L
Department of Ophthalmology and Division of Hematology-Oncology, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario.
Arch Ophthalmol. 2003 Aug;121(8):1120-4. doi: 10.1001/archopht.121.8.1120.
Focal subtenon carboplatin injections have recently been used as a presumably toxicity-free adjunct to systemic chemotherapy for intraocular retinoblastoma.
To report our clinical experience with abnormal ocular motility in patients treated with subtenon carboplatin chemotherapy.
We noted abnormal ocular motility in 10 consecutive patients with retinoblastoma who had received subtenon carboplatin. During ocular manipulation under general anesthesia, we assessed their eyes by forced duction testing, comparing ocular motility after tumor control with ocular motility at diagnosis. Eyes subsequently enucleated because of treatment failure (n = 4) were examined histologically.
Limitation of ocular motility was detected in all 12 eyes of 10 patients treated for intraocular retinoblastoma with 1 to 6 injections of subtenon carboplatin as part of multimodality therapy. Histopathological examination revealed many lipophages in the periorbital fat surrounding the optic nerve in 1 eye, indicative of phagocytosis of previously existing fat cells and suggesting prior fat necrosis. The enucleations were technically difficult and hazardous for globe rupture because of extensive orbital soft tissue adhesions.
Subtenon carboplatin chemotherapy is associated with significant fibrosis of orbital soft tissues, leading to mechanical restriction of eye movements and making subsequent enucleation difficult. Subtenon carboplatin is not free of toxicity, and its use is best restricted to specific indications.
近期，病灶下Tenon囊内注射卡铂已被用作眼内视网膜母细胞瘤全身化疗的一种毒性可能较低的辅助治疗方法。
报告我们在接受Tenon囊内卡铂化疗的患者中观察到的眼球运动异常的临床经验。
我们记录了连续10例接受Tenon囊内卡铂治疗的视网膜母细胞瘤患者的眼球运动异常情况。在全身麻醉下进行眼部操作时，我们通过被动牵拉试验评估他们的眼睛，比较肿瘤得到控制后的眼球运动与诊断时的眼球运动情况。对随后因治疗失败而摘除眼球的4只眼睛进行了组织学检查。
在接受1至6次Tenon囊内注射卡铂作为多模式治疗一部分的10例眼内视网膜母细胞瘤患者的全部12只眼中均检测到眼球运动受限。组织病理学检查显示，1只眼视神经周围眶周脂肪中有许多噬脂细胞，这表明先前存在的脂肪细胞被吞噬，提示先前存在脂肪坏死。由于广泛的眶内软组织粘连，眼球摘除术在技术上具有挑战性，且有眼球破裂的风险。
Tenon囊内卡铂化疗与眶内软组织的显著纤维化有关，导致眼球运动受到机械性限制，并使随后的眼球摘除术变得困难。Tenon囊内卡铂并非没有毒性，其使用最好限于特定适应证。
