Ong Sherine Jue, Chao An-Ning, Wong Ho-Fai, Liou Kuan-Lyin, Kao Ling-Yuh
Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.
Jpn J Ophthalmol. 2015 Mar;59(2):109-17. doi: 10.1007/s10384-014-0356-y. Epub 2014 Dec 3.
To describe tumor response and complications after selective ophthalmic arterial injection (SOAI) of melphalan for treatment of intraocular retinoblastoma.
A retrospective review of 17 eyes (12 patients) treated with SOAI of melphalan from January 2010 through December 2013 at Chang Gung Memorial Hospital.
SOAI was successfully performed in 49 of 54 attempts. Six eyes underwent SOAI as the primary treatment and 11 eyes had previously been treated with other treatment modalities. Subsequent to SOAI, tumor regression was observed in 12 of 17 eyes, and vitreous seeding with complete or partial regression in ten of 15 eyes. Globe salvage was achieved in ten of 17 eyes, with three of four in group B and group C eyes, and seven of 13 in group D and group E eyes. Pancytopenia accompanied by neutropenic fever was observed in one case. Twelve eyes had local side effects, including lid edema (two eyes), third cranial nerve palsy (two eyes), sixth cranial nerve palsy (one eye), chorioretinal atrophy (six eyes), retinal arterial occlusion (three eyes), retinal detachment (one eye), and vitreous hemorrhage (seven eyes). Three cases with high-risk features, according to the histopathologic examination, had metastatic disease, and two of them died.
SOAI of melphalan is an effective treatment for intraocular retinoblastoma, achieving high globe salvage in cases of advanced disease, but can be associated with significant ocular complications. Repetitive SOAI with delayed enucleation could increase the risk of metastasis when used in high-risk cases. Therefore, clinicians should consider the benefits and potential risks and use this new technique with caution.
描述美法仑经选择性眼动脉注射（SOAI）治疗眼内视网膜母细胞瘤后的肿瘤反应及并发症。
回顾性分析2010年1月至2013年12月在长庚纪念医院接受美法仑SOAI治疗的17只眼（12例患者）。
54次尝试中有49次成功完成SOAI。6只眼将SOAI作为主要治疗方法，11只眼此前曾接受过其他治疗方式。SOAI后，17只眼中有12只观察到肿瘤消退，15只眼中有10只出现玻璃体种植且完全或部分消退。17只眼中有10只实现了眼球挽救，B组和C组4只眼中有3只，D组和E组13只眼中有7只。1例出现全血细胞减少伴中性粒细胞减少性发热。12只眼出现局部副作用，包括眼睑水肿（2只眼）、动眼神经麻痹（2只眼）、展神经麻痹（1只眼）、脉络膜视网膜萎缩（6只眼）、视网膜动脉阻塞（3只眼）、视网膜脱离（1只眼）和玻璃体积血（7只眼）。根据组织病理学检查，3例具有高危特征的患者发生了转移性疾病，其中2例死亡。
美法仑SOAI是治疗眼内视网膜母细胞瘤的有效方法，在晚期病例中能实现较高的眼球挽救率，但可能伴有严重的眼部并发症。在高危病例中重复进行SOAI并延迟眼球摘除可能会增加转移风险。因此，临床医生应权衡利弊，谨慎使用这项新技术。
