Intraocular Surgery with Melphalan Irrigation for Vitreous Hemorrhage in an Only Eye with Retinoblastoma

Yarovoy, А.А.; Ushakova, T.L.; Gorshkov, I.M.; Polyakov, V.G.; Голубева, О. В.; Горовцова, О. В.; Krivovyaz, O.S.

doi:10.5301/ejo.5000683

Cited by 20 publications

(16 citation statements)

References 7 publications

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“…If an intraocular procedure is preferred, tumor reactivation should be ruled out as the cause of the detachment. Pars plana vitrectomy (23 or 25G) with melphalan irrigation (5 μg/ml) with or without silicone oil tamponade is possible (Yarovoy et al, 2015). In the case of retinal detachment occurring concomitantly to proliferative vitreoretinopathy, with or without retinal dehiscence, an intravitreal anti-VEGF injection can be successfully given one week prior to vitrectomy under melphalan infusion combined with retinotomy (Stathopoulos et al, 2018a).…”

Section: Surgical Repairmentioning

confidence: 99%

Conservative management of retinoblastoma: Challenging orthodoxy without compromising the state of metastatic grace. “Alive, with good vision and no comorbidity”

Munier

Beck‐Popovic

Chantada

et al. 2019

Progress in Retinal and Eye Research

164

157

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Retinoblastoma is lethal by metastasis if left untreated, so the primary goal of therapy is to preserve life, with ocular survival, visual preservation and quality of life as secondary aims. Historically, enucleation was the first successful therapeutic approach to decrease mortality, followed over 100 years ago by the first eye salvage attempts with radiotherapy. This led to the empiric delineation of a window for conservative management subject to a "state of metastatic grace" never to be violated. Over the last two decades, conservative management of retinoblastoma witnessed an impressive acceleration of improvements, culminating in two major paradigm shifts in therapeutic strategy. Firstly, the introduction of systemic chemotherapy and focal treatments in the late 1990s enabled radiotherapy to be progressively abandoned. Around 10 years later, the advent of chemotherapy in situ, with the capitalization of new routes of targeted drug delivery, namely intra-arterial, intravitreal and now intracameral injections, allowed significant increase in eye preservation rate, definitive eradication of radiotherapy and reduction of systemic chemotherapy. Here we intend to review the relevant knowledge susceptible to improve the conservative management of retinoblastoma in compliance with the "state of metastatic grace", with particular attention to (i) reviewing how new imaging modalities impact the frontiers of conservative management, (ii) dissecting retinoblastoma genesis, growth patterns, and intraocular routes of tumor propagation, (iii) assessing major therapeutic changes and trends, (iv) proposing a classification of relapsing retinoblastoma, (v) examining treatable/preventable disease-related or treatment-induced complications, and (vi) appraising new therapeutic targets and concepts, as well as liquid biopsy potentiality.

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Section: Surgical Repairmentioning

confidence: 99%

Conservative management of retinoblastoma: Challenging orthodoxy without compromising the state of metastatic grace. “Alive, with good vision and no comorbidity”

Munier

Beck‐Popovic

Chantada

et al. 2019

Progress in Retinal and Eye Research

164

157

View full text Add to dashboard Cite

show abstract

“…With the rapid development of local chemotherapy treatments in recent years, this situation may come to an end. Several studies have reported on the combined use of IViC and PPV for advanced retinoblastoma in small sample cases [ 9 , 10 , 13 ]. Recently, Zhao et al reported on planned PPV with IViC in 21 cases of refractory retinoblastoma, with eye preservation achieved in 85.7% (18/21) of the cases with a median of 5.1 years of follow-up [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Theoretically, endoresection by pars plana vitrectomy (PPV) is the ideal way to eradicate a tumour and solve vitreoretinal complications, but its use in the treatment of retinoblastoma has been controversial due to the high risk of metastasis, orbital seeding and extraocular extension [8]. However, the recent success of IViC has raised the possibility of surgical intervention again [9,10]. In this study, we attempted IViC-assisted endoresection in refractory monocular ICRB group D retinoblastoma patients.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of intravitreal chemotherapy-assisted endoresection in monocular patients with group D retinoblastoma

Xing

et al. 2020

BMC Cancer

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Background: This study aimed to determine the efficacy and complications of intravitreal chemotherapy-assisted endoresection for refractory International Classification of Retinoblastoma (ICRB) group D retinoblastoma in monocular patients. Methods: In this retrospective case series, intravitreal chemotherapy-assisted endoresection by pars plana vitrectomy was performed in 11 eyes with refractory ICRB group D retinoblastoma unresponsive to standard therapies in monocular patients. Results: Across a mean follow-up period of 42.7 months, globe salvage was attained in all 11 eyes (100%). There were no cases of extra-ocular tumour seeding or remote metastasis. In 9 eyes (81.8%), tumour control was achieved with one pars plana vitrectomy; in 2 cases (18.2%), repeated treatment, such as laser therapy, intravitreal chemotherapy or a second pars plana vitrectomy, was needed. Retinal reattachment was achieved in all 4 eyes (100%) with previous retinal detachment. Four eyes (36.4%) required subsequent cataract surgery due to secondary cataract. Ten eyes (90.9%) had improvement in best-corrected visual acuity at the last follow-up. Conclusion: Intravitreal chemotherapy-assisted endoresection appears to be a safe and effective globe-salvaging method for refractory group D retinoblastoma. It is a promising alternative to enucleation and a supplementary therapeutic strategy for those unresponsive to standard therapies, especially for the monocular retinoblastoma patients.

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“…With the rapid development of local chemotherapy treatments in recent years, this situation may come to an end. Several studies have reported on the combined use of IViC and PPV for advanced retinoblastoma in small sample cases (9,10,13) . Recently, Zhao et al reported on planned PPV with IViC in 21 cases of refractory retinoblastoma, with eye preservation achieved in 85.7%…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Intravitreal Chemotherapy-Assisted Endoresection in Monocular Patients with Group D Retinoblastoma

Xing

et al. 2020

Preprint

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Abstract Background: To determine the efficacy and complications of intravitreal chemotherapy-assisted endoresection for refractory group D retinoblastoma in monocular patients.Methods: In this retrospective case series, intravitreal chemotherapy-assisted endoresection by pars plana vitrectomy was performed in 11 eyes with refractory ICRB group D retinoblastoma unresponsive to standard therapies in monocular patients.Results: Across a mean follow-up period of 42.7 months, globe salvage was attained in all 11 eyes (100%). There was no case of extra-ocular tumor seeding or remote metastasis. In 9 eyes (81.8%), tumor control was achieved with one-time pars plana vitrectomy, whereas in 2 cases (18.2%), repeated treatment such as laser, intravitreal chemotherapy or second pars plana vitrectomy were needed. Retinal reattachment was achieved in all 4 eyes (100%) with previous retinal detachment. 4 eyes (36.4%) required subsequent cataract surgery due to secondary cataract. 10 eyes (90.9%) had improvement in best-corrected visual acuity at the last follow-up.Conclusion: Intravitreal chemotherapy-assisted endoresection appears to be a safe and effective globe-salvaging method for refractory group D retinoblastoma. It is a promising alternative to enucleation and a supplementary therapeutic strategy for those unresponsive to standard therapies, especially for the monocular retinoblastoma patients.

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Intraocular Surgery with Melphalan Irrigation for Vitreous Hemorrhage in an Only Eye with Retinoblastoma

Abstract: Despite the high risk of intraocular surgery, the need to preserve the only potentially seeing eye with treated retinoblastoma may require PPV. Thus, in unclear cases of VH with suspected viable tumor, PPV with intraocular melphalan irrigation, with caution, may be a reasonable procedure.

Cited by 20 publications

References 7 publications

Conservative management of retinoblastoma: Challenging orthodoxy without compromising the state of metastatic grace. “Alive, with good vision and no comorbidity”

Conservative management of retinoblastoma: Challenging orthodoxy without compromising the state of metastatic grace. “Alive, with good vision and no comorbidity”

Effectiveness of intravitreal chemotherapy-assisted endoresection in monocular patients with group D retinoblastoma

Effectiveness of Intravitreal Chemotherapy-Assisted Endoresection in Monocular Patients with Group D Retinoblastoma

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