ERG and OCT abnormalities in retinoblastoma after melphalan intravitreous injection

Abstract

The authors report full-field electroretinogram and optical coherence tomography findings of intravitreal melphalan retinal toxicity. An 18-month-old girl with unilateral group D retinoblastoma was evaluated with light-adapted 3 full-field electroretinogram protocol and optical coherence tomography (I-Stand optical coherence tomography, Optovue) after treatment with intravitreal melphalan for active vitreous seeds. After the third injection, the child developed retinal pigment epithelial changes near the injection site. The photopic response of the full-field electroretinogram standard flash cones showed a decrease in amplitude responses of waves a and b in the affected eye compared to the contralateral eye. Optical coherence tomography showed loss of photoreceptors and outer nuclear layers in the affected eye. Melphalan toxicity is dose-dependent, and despite its treatment benefits, it can affect vision. Our case shows an updated, in-depth retinal toxicity assessment of intravitreal melphalan in the human retina with optical coherence tomography and its correlation with electroretinogram changes.

Intravitreal Melphalan Injection as a Second-line Local Therapy in Vitreoretinal Lymphoma: Case series

“…17 In children, RPE and electroretinography abnormalities were reported to be associated with the use of IVM. 8,[18][19][20] The retinal toxicity of IVM is thought to be dose-dependent and related to vascular changes such as occlusion or neovascularization or direct toxic effect. 20 We observed chorioretinal atrophy in the peripheral retina in five eyes.…”

“…8,[18][19][20] The retinal toxicity of IVM is thought to be dose-dependent and related to vascular changes such as occlusion or neovascularization or direct toxic effect. 20 We observed chorioretinal atrophy in the peripheral retina in five eyes. All eyes had some RPE changes in the peripheral fundus.…”