Aqueous seeding in intraocular retinoblastoma: A review

Kaliki, Swathi

doi:10.1111/ceo.13964

Cited by 8 publications

(6 citation statements)

References 41 publications

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“…As a result, clinicians are observing AC seeds or Schlemm canal invasion in eyes with useful vision, a situation that was previously uncommon. Anterior chamber seeds could be primary in cases of anterior segment invasion, especially in patients with ciliary body infiltration resulting in contaminated aqueous or secondary to spillover of endophytic retinal tumor or vitreous seeds at the vitreous base or ciliary body area . This infiltration is managed in selective cases with intracameral chemotherapy or plaque radiotherapy with acceptable outcomes, with no evidence of systemic metastasis during a short-term follow-up period .…”

Section: Discussionmentioning

confidence: 99%

Defining High-risk Retinoblastoma

et al. 2022

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High-risk histopathologic features of retinoblastoma are useful to assess the risk of systemic metastasis. In this era of globe salvage treatments for retinoblastoma, the definition of high-risk retinoblastoma is evolving.OBJECTIVE To evaluate variations in the definition of high-risk histopathologic features for metastasis of retinoblastoma in different ocular oncology practices around the world.DESIGN, SETTING, AND PARTICIPANTS An electronic web-based, nonvalidated 10-question survey was sent in December 2020 to 52 oncologists and pathologists treating retinoblastoma at referral retinoblastoma centers.INTERVENTION Anonymized survey about the definition of high-risk histopathologic features for metastasis of retinoblastoma. MAIN OUTCOMES AND MEASURESHigh-risk histopathologic features that determine further treatment with adjuvant systemic chemotherapy to prevent metastasis. RESULTS Among the 52 survey recipients, the results are based on the responses from 27 individuals (52%) from 24 different retinoblastoma practices across 16 countries in 6 continents. The following were considered to be high-risk features: postlaminar optic nerve infiltration ( 27[100%]), involvement of optic nerve transection (27 [100%]), extrascleral tissue infiltration (27 [100%]), massive (Ն3 mm) choroidal invasion (25 [93%]), microscopic scleral infiltration (23 [85%]), ciliary body infiltration (20 [74%]), trabecular meshwork invasion (18 [67%]), iris infiltration (17 [63%]), anterior chamber seeds (14 [52%]), laminar optic nerve infiltration (13 [48%]), combination of prelaminar and laminar optic nerve infiltration and minor choroidal invasion (11 [41%]), minor (<3 mm) choroidal invasion (5 [19%]), and prelaminar optic nerve infiltration (2 [7%]). The other histopathologic features considered high risk included Schlemm canal invasion (4 [15%]) and severe anaplasia (1 [4%]).Four respondents (15%) said that the presence of more than 1 high-risk feature, especially a combination of massive peripapillary choroidal invasion and postlaminar optic nerve infiltration, should be considered very high risk for metastasis. CONCLUSIONS AND RELEVANCEResponses to this nonvalidated survey conducted in 2020-2021 showed little uniformity in the definition of high-risk retinoblastoma. Postlaminar optic nerve infiltration, involvement of optic nerve transection, and extrascleral tumor extension were the only features uniformly considered as high risk for metastasis across all oncology practices. These findings suggest that the relevance about their value in the current scenario with advanced disease being treated conservatively needs further evaluation; there is also a need to arrive at consensus definitions and conduct prospective multicenter studies to understand their relevance.

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Section: Discussionmentioning

confidence: 99%

Defining High-risk Retinoblastoma

et al. 2022

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“…Nevertheless, some authors only inject a small amount of the drug into the AC, with or without paracentesis. 79 When combined with plaque radiotherapy, IcamC led to complete tumor control in a patient who was followed up for 3 years. 80 One study found that IcamC and intravitreal therapy provided good efficacy in treating lesions of the ciliary body and AC.…”

Section: Intracameral Chemotherapymentioning

confidence: 97%

“…Nevertheless, some authors only inject a small amount of the drug into the AC, with or without paracentesis. 79 …”

Section: Intracameral Chemotherapymentioning

confidence: 99%

“…Therefore, it is of utmost importance to inject the chemotherapeutic agent in both the AC and PC, as well as the epiciliary region. 79 The agents used in IcamC are melphalan (15–20 μg/0.05 mL) and topotecan (7.5 μg/0.015 mL). The original technique involved complete paracentesis of aqueous humor from both AC and PC through a long small-gauge needle placed at the periphery of the cornea.…”

Section: Intracameral Chemotherapymentioning

confidence: 99%

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Spotlight on Targeted Chemotherapy in Retinoblastoma: Safety, Efficacy, and Patient Outcomes

Naseripour¹,

Mirshahi²,

Kasraei³

et al. 2022

OTT

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As the most common primary intraocular malignancy of childhood, retinoblastoma (RB) has had a complex journey in its management, following a course from enucleation as the first life-saving treatment to numerous globe-salvaging therapies during the last century. Currently, this potentially lethal disease has achieved high survival rates owing to multidisciplinary management and the introduction of neoadjuvant and multimodal chemotherapy. Therefore, the goal of treatment is shifting toward conserving the globe and vision as much as possible. Up until recently, many advanced cases of RB were enucleated primarily; however, targeted chemotherapy via the ophthalmic artery and management of intraocular seeding by local administration of chemotherapeutic agents have revolutionized the globe-conserving therapies. The added benefit of avoiding systemic complications of cytotoxic drugs resulted in these methods gaining popularity, and they are becoming a main part of care in many referral centers. Initially, there were some safety concerns regarding these approaches; however, increasing experience has shown that these modalities are relatively safe procedures and many complications can be averted by changing the choice of the drug and using some prophylactic measures. It is hoped that, in the near future, with advances in early diagnosis and patient-targeted molecular therapies, as well as gene-editing techniques, the patient's vision can be saved even in advanced RB.

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“…Kaliki's article 10 described the current management of aqueous seeding in intraocular retinoblastoma. This review emphasised the need for thorough assessment of seeding using high‐resolution ultrasound biomicroscopy and anterior segment optical coherence tomography, before initiating globe salvage therapies.…”

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confidence: 99%