Francis Jasmine H, Marr Brian P, Brodie Scott E, Abramson David H
Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.
Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York2Department of Ophthalmology, Weill Cornell Medical College, New York, New York.
JAMA Ophthalmol. 2015 Dec;133(12):1459-63. doi: 10.1001/jamaophthalmol.2015.3119.
Intravitreous injections of melphalan hydrochloride are increasingly used in the treatment of vitreous seeding of retinoblastoma. Although this technique can save eyes otherwise destined for enucleation, ocular salvage may be accompanied by local toxic effects. Posterior segment toxic effects in this context are well established. This report describes the toxic effects on the anterior segment following intravitreous administration of melphalan.
Our clinic cohort included 76 patients who received intravitreous injections of melphalan at Memorial Sloan Kettering Cancer Center from September 12, 2012, through April 15, 2015; data analysis was performed from April 15 through May 15, 2015. We report a series of 5 patients from this cohort who developed anterior segment toxic effects. These abnormalities were found at the injection site or within the meridian of the injection and included a traumatic cataract following an injection at an outside hospital, iris depigmentation and thinning, iris recession with retinal necrosis and hypotony, a filtering conjunctival bleb, and focal scleromalacia with localized pigmentation.
Intravitreous injection of melphalan may result in toxic effects on the anterior segment of the eye, in addition to retinal abnormalities, and appears to be more common in the meridian of the injection where the drug concentration is highest.
玻璃体内注射盐酸美法仑越来越多地用于治疗视网膜母细胞瘤的玻璃体种植。尽管该技术可挽救原本注定要被摘除的眼睛，但眼球挽救可能伴有局部毒性作用。在这种情况下，眼后段毒性作用已得到充分证实。本报告描述了玻璃体内注射美法仑后对眼前段的毒性作用。
我们的临床队列包括2012年9月12日至2015年4月15日在纪念斯隆凯特琳癌症中心接受玻璃体内注射美法仑的76例患者；数据分析于2015年4月15日至5月15日进行。我们报告了该队列中的5例患者出现了眼前段毒性作用。这些异常发现在注射部位或注射子午线范围内，包括在外部医院注射后出现的外伤性白内障、虹膜色素脱失和变薄、伴有视网膜坏死和低眼压的虹膜后缩、滤过性结膜泡以及伴有局部色素沉着的局灶性巩膜软化。
玻璃体内注射美法仑除可导致视网膜异常外，还可能对眼球前段产生毒性作用，且在药物浓度最高的注射子午线范围内似乎更为常见。
