Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
Department of Ophthalmology, Weill-Cornell Medical Center, New York, New York
JAMA Ophthalmol. 2017 Dec 1;135(12):1426-1429. doi: 10.1001/jamaophthalmol.2017.4600.
The risk of extraocular extension from injecting chemotherapy into eyes with retinoblastoma is minimally understood; however, understanding this risk is important because of the increasing use of intravitreous chemotherapy.
To evaluate the risk of extraocular extension in eyes with retinoblastoma that have received intravitreous chemotherapy injections.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was performed in 655 patients at 10 retinoblastoma centers in North and South American, European, Israeli, and Chinese centers. Physicians at the retinoblastoma centers administered more than 120 intravitreous chemotherapy injections in eyes with retinoblastoma from February 1, 1999, through February 28, 2017.
Risk of extraocular extension with secondary observational variables, including injection and precautionary techniques.
A total of 3553 intravitreous chemotherapy injections (3201 melphalan hydrochloride, 335 topotecan hydrochloride, and 17 methotrexate sodium) were administered to 704 eyes in 655 patients with retinoblastoma (mean [SD] age of patients at the time of the initial injections, 31.6 [11.6] months; 348 male [53.1%]). There were no extraocular tumor events related to prior intravitreous injections. This finding resulted in a calculated proportion of zero extraocular events per eye. According to the rule of 3, the risk is no greater than 0.08% injections. All 10 centers included in this study used at least 2 presumed precautionary injection methods (lowering of intraocular pressure, cryotherapy, ocular surface irrigation, ultrasonic biomicroscopy surveillance of the injection site, and subconjunctival chemotherapy deposition).
With use of at least 2 presumed precautionary safety methods, no extraocular extension of tumor events occurred. According to the rule of 3, this finding suggests that the risk is no greater than 0.08% injections.
将化疗药物注射到患有视网膜母细胞瘤的眼睛中导致眼外延伸的风险尚未被充分了解；然而，由于越来越多地使用眼内化疗，了解这种风险非常重要。
评估接受眼内化疗注射的视网膜母细胞瘤眼中发生眼外延伸的风险。
设计、设置和参与者：这是一项在北美、南美、欧洲、以色列和中国的 10 个视网膜母细胞瘤中心的 655 名患者中进行的回顾性队列研究。来自视网膜母细胞瘤中心的医生在 1999 年 2 月 1 日至 2017 年 2 月 28 日期间，对患有视网膜母细胞瘤的眼睛进行了超过 1200 次眼内化疗注射。
眼外延伸的风险，以及包括注射和预防措施在内的次要观察变量。
共对 655 名患有视网膜母细胞瘤的患者的 704 只眼进行了 3553 次眼内化疗注射（3201 次盐酸氨苯砜、335 次盐酸拓扑替康和 17 次甲氨蝶呤钠）（患者在初次注射时的平均[标准差]年龄为 31.6[11.6]个月；男性 348 名[53.1%]）。没有与先前眼内注射相关的眼外肿瘤事件。这一发现导致每只眼的零眼外事件比例。根据 3 规则，风险不大于 0.08%的注射。本研究中包括的所有 10 个中心都使用了至少 2 种预防注射方法（降低眼内压、冷冻疗法、眼表面冲洗、注射部位超声生物显微镜监测和结膜下化疗沉积）。
使用至少 2 种预防安全方法，没有发生肿瘤事件的眼外延伸。根据 3 规则，这一发现表明风险不大于 0.08%的注射。
