Yu Michael D, Dalvin Lauren A, Welch R Joel, Shields Carol L
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.
Ocul Oncol Pathol. 2019 Jun;5(4):284-289. doi: 10.1159/000491432. Epub 2018 Sep 13.
To describe and evaluate the effectivity of a novel precision intravitreal injection technique for select cases of localized vitreous seeding in retinoblastoma.
Patients with localized vitreous seeds from retinoblastoma received intravitreal chemotherapy via a precision injection technique (P-IVitC) intended to optimize local delivery of melphalan to target seeds. The needle was inserted trans-pars plana and chemotherapy deposited within 3 mm of the target seed(s) under indirect ophthalmoscopic guidance. Without subsequent globe manipulation, the head was then positioned to promote gravity-dependent settling of chemotherapy.
There were 8 eyes of 8 patients treated with P-IVitC for active vitreous seeds following adequate solid tumor control with intravenous chemotherapy ( = 3, 38%) or intra-arterial chemotherapy ( = 5, 63%). Viable vitreous seeds were primarily solitary spheres ( = 6, 75%) and measured an average of 2.7 mm in diameter. Vitreous seed resolution ( = 8, 100%) was noted after a mean of 2.6 injections (median 2; range 1-3) of 20 μg melphalan. There was no recurrence at a mean follow-up of 10.0 months. Only 1 eye had an associated complication (focal retinal pigment epithelial mottling, = 1, 13%).
With direct delivery of chemotherapy to within 3-4 mm of vitreous seed activity, P-IVitC provided complete control of localized vitreous seeds with minimal toxicity.
描述并评估一种新型精准玻璃体内注射技术对视网膜母细胞瘤局限性玻璃体种植特定病例的有效性。
患有视网膜母细胞瘤局限性玻璃体种植的患者通过一种精准注射技术（P-IVitC）接受玻璃体内化疗，该技术旨在优化美法仑向目标种植体的局部递送。针经睫状体扁平部插入，在间接检眼镜引导下将化疗药物注射到距目标种植体3毫米范围内。在不进行后续眼球操作的情况下，然后调整头部位置以促进化疗药物依靠重力沉降。
8例患者的8只眼在通过静脉化疗（n = 3，38%）或动脉内化疗（n = 5，63%）充分控制实体瘤后，接受P-IVitC治疗活动性玻璃体种植。存活的玻璃体种植主要为单个球体（n = 6，75%），平均直径为2.7毫米。在平均注射2.6次（中位数2次；范围1 - 3次）20μg美法仑后，玻璃体种植消失（n = 8，100%）。平均随访10.0个月时无复发。仅1只眼出现相关并发症（局灶性视网膜色素上皮斑纹，n = 1，13%）。
通过将化疗药物直接递送至玻璃体种植活动范围内3 - 4毫米处，P-IVitC以最小的毒性实现了对局限性玻璃体种植的完全控制。
