玻璃体内注射美法仑作为难治性视网膜及视网膜下视网膜母细胞瘤的挽救治疗
INTRAVITREAL MELPHALAN AS SALVAGE THERAPY FOR REFRACTORY RETINAL AND SUBRETINAL RETINOBLASTOMA.
作者信息
Francis Jasmine H, Marr Brian P, Brodie Scott E, Gobin Pierre, Dunkel Ira J, Abramson David H
机构信息
*Memorial Sloan Kettering Cancer Center, New York, New York; †Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York; and ‡Icahn School of Medicine at Mount Sinai, New York, New York.
出版信息
Retin Cases Brief Rep. 2016 Fall;10(4):357-60. doi: 10.1097/ICB.0000000000000262.
PURPOSE
This case series highlights the novel use of intravitreal melphalan for nonvitreous retinoblastoma. It assesses the efficacy and toxicity of intravitreal melphalan for nonvitreous retinoblastoma.
METHODS
This observational small case series investigates three patients treated with intravitreal melphalan for nonvitreous retinoblastoma that was refractory to multiple-course ophthalmic artery chemosurgery. Patients' demographics, response to treatment, and toxicity of treatment as clinically evaluated are measured by electroretinogram.
PATIENTS
Three eyes of three patients received a median of 7 weekly intravitreal melphalan injections (30 μg/0.07 cc) for persistent retinal or subretinal tumors refractory to treatment with multiple-course ophthalmic artery chemosurgery.
RESULTS
Eyes remain tumor free at a median of 14-month follow-up. One eye was enucleated because of a vitreous hemorrhage that obscured fundus details. One eye had extinguished electroretinogram recordings before injections and two eyes had a decrease in electroretinogram responses over the intravitreal treatment course. The eye with subretinal seeding demonstrated marked retinopathy by ophthalmoscopy and fluorescein angiography and one eye was enucleated because of the development of a vitreous hemorrhage.
CONCLUSION
This small case series highlights that nonvitreous disease that is, refractory or persistent despite previous ophthalmic artery chemosurgery can regress with intravitreal melphalan. However, this treatment may result in retinal toxicity.
目的
本病例系列突出了玻璃体内注射美法仑在非玻璃体视网膜母细胞瘤中的新用途。它评估了玻璃体内注射美法仑治疗非玻璃体视网膜母细胞瘤的疗效和毒性。
方法
这个观察性小病例系列研究了3例接受玻璃体内注射美法仑治疗的非玻璃体视网膜母细胞瘤患者，这些患者对多疗程眼动脉化疗手术无效。通过视网膜电图测量患者的人口统计学特征、对治疗的反应以及临床评估的治疗毒性。
患者
3例患者的3只眼接受了中位7次每周一次的玻璃体内美法仑注射（30μg/0.07cc），用于治疗对多疗程眼动脉化疗手术无效的持续性视网膜或视网膜下肿瘤。
结果
在中位14个月的随访中，患眼保持无肿瘤状态。1只眼因玻璃体积血遮挡眼底细节而被摘除眼球。1只眼在注射前视网膜电图记录消失，2只眼在玻璃体内治疗过程中视网膜电图反应降低。视网膜下播散的患眼通过检眼镜检查和荧光素血管造影显示有明显的视网膜病变，1只眼因玻璃体积血而被摘除眼球。
结论
这个小病例系列突出表明，尽管先前进行了眼动脉化疗手术，但难治性或持续性的非玻璃体疾病可通过玻璃体内注射美法仑消退。然而，这种治疗可能会导致视网膜毒性。
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