McAnena Lisa, Naeem Zishan, Duncan Catriona, Robertson Fergus, Sagoo Mandeep S, Reddy M Ashwin
Retinoblastoma Service, Royal London Hospital, Whitechapel Road, Whitechapel, London, E1 1BB, UK.
Great Ormond Street Hospital for Children, London, UK.
Am J Ophthalmol Case Rep. 2020 Jan 30;18:100611. doi: 10.1016/j.ajoc.2020.100611. eCollection 2020 Jun.
Intra-arterial chemotherapy (IAC), delivered directly to the globe via the internal carotid artery is now an established treatment for retinoblastoma. We report a case of anterior segment ischaemia following treatment with multiple intra-arterial chemotherapy (IAC) infusions.
A 5 month old female presented with bilateral retinoblastoma and was treated with 12 infusions of IAC. Her right eye was enucleated at diagnosis. After her seventh IAC treatment, she developed ipsilateral sixth and third cranial nerve palsies. After the twelfth IAC, she developed an area of conjunctival and scleral ischaemia between 12 and 3 o'clock meridians in her left eye. However, she maintained visual acuity of LogMAR 0.34.
The median number of IAC treatments in large studies is three. It is possible that repeated doses of IAC have an accumulative negative effect on the ocular blood supply, risking anterior segment and neurologic sequelae. This case highlights the significant challenge of balancing the salvage of eyes and vision with the potentially significant morbidity associated with IAC.
经颈内动脉直接向眼球输送的动脉内化疗（IAC）现已成为视网膜母细胞瘤的一种既定治疗方法。我们报告一例在多次动脉内化疗（IAC）输注治疗后出现眼前段缺血的病例。
一名5个月大的女性患双侧视网膜母细胞瘤，接受了12次IAC输注治疗。诊断时她的右眼被摘除。在她接受第七次IAC治疗后，出现同侧第六和第三颅神经麻痹。在第十二次IAC治疗后，她左眼12点至3点子午线之间出现结膜和巩膜缺血区域。然而，她的视力维持在LogMAR 0.34。
大型研究中IAC治疗的中位数次数为三次。重复剂量的IAC可能对眼部血液供应产生累积负面影响，有导致眼前段和神经后遗症的风险。该病例凸显了在挽救眼睛和视力与IAC相关的潜在严重发病率之间取得平衡的重大挑战。
