Jules Gonin Eye Hospital, Lausanne, Switzerland.
Retina. 2011 Mar;31(3):566-73. doi: 10.1097/IAE.0b013e318203c101.
Superselective ophthalmic artery chemotherapy (SOAC) has recently been proposed as an alternative to intravenous chemoreduction for advanced intraocular retinoblastoma. Preliminary results appear promising in terms of tumor control and eye conservation, but little is known regarding ocular toxicity and visual prognosis. In this study, we report on the vascular adverse effects observed in our initial cohort of 13 patients.
The charts of 13 consecutive patients with retinoblastoma who received a total of 30 injections (up to 3 injections of a single agent per patient at 3-week interval) of melphalan (0.35 mg/kg) in the ophthalmic artery between November 2008 and June 2010 were retrospectively reviewed. RetCam fundus photography and fluorescein angiography were performed at presentation and before each injection. Vision was assessed at the latest visit.
Enucleation and external beam radiotherapy could be avoided in all cases but one, with a mean follow-up of 7 months. Sectoral choroidal occlusive vasculopathy leading to chorioretinal atrophy was observed temporally in 2 eyes (15%) 3 weeks to 6 weeks after the beginning of SOAC and retinal arteriolar emboli in 1 eye 2 weeks after injection. There was no stroke or other clinically significant systemic side effects except a perioperative transient spasm of the internal carotid artery in one patient. Vision ranged between 20/1600 and 20/32 depending on the status of the macula.
Superselective ophthalmic artery chemotherapy was effective in all patients with no stroke or other systemic vascular complications. Unlike intravenous chemoreduction, SOAC is associated with potentially sight-threatening adverse effects, such as severe chorioretinal atrophy secondary to subacute choroidal occlusive vasculopathy or central retinal artery embolism, not to mention the risk of ophthalmic artery obstruction, which was not observed in this series. Further analysis of the risks and benefits of SOAC will define its role within the therapeutic arsenal. Meanwhile, we suggest that SOAC should be given in one eye only and restricted to advanced cases of retinoblastoma, as an alternative to enucleation and/or external beam radiotherapy.
最近提出了超选择性眼动脉化疗（SOAC）作为治疗晚期眼内视网膜母细胞瘤的静脉化学减容的替代方法。在肿瘤控制和保留眼球方面，初步结果似乎很有希望，但对于眼毒性和视力预后知之甚少。在本研究中，我们报告了我们最初的 13 例患者队列中观察到的血管不良事件。
回顾性分析 2008 年 11 月至 2010 年 6 月期间，13 例连续接受眼动脉注射甲氨蝶呤（0.35mg/kg）共 30 次（每位患者最多 3 次单药注射，间隔 3 周）的视网膜母细胞瘤患者的病历。在就诊时和每次注射前进行 RetCam 眼底摄影和荧光素血管造影。在最近一次就诊时评估视力。
除 1 例外，所有病例均避免了眼摘和外照射放疗，平均随访 7 个月。SOAC 开始后 3 至 6 周，2 只眼（15%）出现节段性脉络膜闭塞性血管病导致脉络膜视网膜萎缩，1 只眼在注射后 2 周出现视网膜小动脉栓塞。除 1 例患者在围手术期短暂发生颈内动脉痉挛外，无中风或其他有临床意义的系统性副作用。视力范围为 20/1600 至 20/32，取决于黄斑状态。
超选择性眼动脉化疗对所有患者均有效，无中风或其他系统性血管并发症。与静脉化学减容不同，SOAC 与潜在威胁视力的不良事件相关，如继发于亚急性脉络膜闭塞性血管病或中央视网膜动脉栓塞的严重脉络膜视网膜萎缩，更不用说眼动脉阻塞的风险，本系列中未观察到该风险。进一步分析 SOAC 的风险和益处将确定其在治疗武器库中的作用。同时，我们建议仅在一只眼进行 SOAC，并将其限于晚期视网膜母细胞瘤，作为眼摘和/或外照射放疗的替代方法。
