Ghassemi Fariba, Shields Carol L
Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
Arch Ophthalmol. 2012 Oct;130(10):1268-71. doi: 10.1001/archophthalmol.2012.1983.
To evaluate the efficacy and complications of intravitreal chemotherapy for viable vitreous seeding from retinoblastoma.
Intravitreal injection of melphalan (8-50 μg in 0.05 mL) followed by injection site cryotherapy.
Among 12 treated cases, success with control of vitreous seeds was achieved in 10 of 12 cases at immediate follow-up (0-3 months), 8 of 10 cases at short-term follow-up (3-6 months), and 6 of 10 cases at long-term (>6 months) follow-up. Among those 8 cases that received an 8- to 10-μg dose, control was achieved in 6 of 8 cases at immediate follow-up, 5 of 7 cases at short-term follow-up, and 3 of 7 cases at long-term follow-up. Complications with the 8- to 10-μg dose were minor and included preretinal hemorrhage and retinal vasculitis with retinal pigment epithelial alterations. Of those 4 that received a 50-μg dose, immediate, short-term, and long-term control was 100%, but complications of cataract, vitreous hemorrhage, subretinal hemorrhage, severe hypotonia, and phthisis lead to enucleation in 2 cases. There was no case of orbital tumor recurrence or retinoblastoma metastasis (follow-up range, 8-66 months).
Intravitreal melphalan for recurrent vitreous seeds from retinoblastoma appears to provide vitreous seed control in some patients. A high dose (50 μg) of melphalan is toxic and should be avoided.
评估玻璃体内化疗对视网膜母细胞瘤存活玻璃体种植灶的疗效及并发症。
玻璃体内注射美法仑（0.05 mL含8 - 50 μg），随后对注射部位进行冷冻疗法。
12例接受治疗的病例中，12例中有10例在即刻随访（0 - 3个月）时成功控制玻璃体种植灶，10例中有8例在短期随访（3 - 6个月）时成功控制，10例中有6例在长期随访（>6个月）时成功控制。在接受8 - 10 μg剂量的8例患者中，8例中有6例在即刻随访时成功控制，7例中有5例在短期随访时成功控制，7例中有3例在长期随访时成功控制。8 - 10 μg剂量的并发症较轻微，包括视网膜前出血和伴有视网膜色素上皮改变的视网膜血管炎。在接受50 μg剂量的4例患者中，即刻、短期和长期控制率均为100%，但白内障、玻璃体积血、视网膜下出血、严重低眼压和眼球痨等并发症导致2例患者眼球摘除。无眼眶肿瘤复发或视网膜母细胞瘤转移病例（随访范围为8 - 66个月）。
玻璃体内注射美法仑治疗视网膜母细胞瘤复发性玻璃体种植灶似乎能在部分患者中控制玻璃体种植灶。高剂量（50 μg）美法仑有毒性，应避免使用。
