Management of cataracts secondary to intravitreal chemotherapy injections for retinoblastoma seeding

Abstract

Purpose: To report our experience in the management of cataracts presumably due to intravitreal chemotherapy administration in eyes with vitreous disease associated with retinoblastoma. Methods: This retrospective study consisted of a cohort of five eyes of five retinoblastoma patients who developed cataracts secondary to intravitreal chemotherapy administration and who then underwent cataract surgery. All patients underwent lensectomy and anterior vitrectomy with/without intraocular lens implantation via clear corneal approach. All cases were administered intraoperative intravitreal melphalan (35–40 mcg) and topotecan (10–20 mcg) at the end of cataract surgery as a preventive measure against retinoblastoma spread. Injections were repeated as needed in monthly follow-ups. Main outcome measures were enucleation rate and disease-free survival time. Results: The age at surgery ranged between 5 and 10 years. Follow-up time varied from 12 to 16 months. Treatment-free period before surgery ranged between 3 and 20 months. Time from last injection to cataract detection was: 2, 2, 10, 6, and 7 months; and time from last injection to cataract surgery was: 8, 3, 20, 7, and 15 months in cases 1–5, respectively. None of the eyes required enucleation. Tumor control was achieved in all patients at the end of follow-up. Conclusions: Injection of melphalan and topotecan into anterior parts of the vitreous may lead to cataract formation. This can be safely managed with lensectomy and anterior vitrectomy and the use of intravitreal administration of melphalan and topotecan at the conclusion of the surgery as a precautionary measure against the potential risk of extraocular spread.

Strabismus management in retinoblastoma survivors

“…Intraocular surgeries in eyes with Rb remains strongly associated with challenges and the major concerns are extraocular spread and distant metastases [ 19 , 20 ]. In patients with retinoblastoma, it is commonly accepted that intraocular surgeries (e.g.…”

“…In patients with retinoblastoma, it is commonly accepted that intraocular surgeries (e.g. cataract surgery) should be delayed until complete tumor control is achieved, but there is controversy regarding the best time for doing surgery [ 19 – 20 ]. It is recommended to postpone these surgeries between 18 and 24 months after complete tumor control [ 20 ].…”

Intravitreal chemotherapy-induced cataract in retinoblastoma: challenges and outcome

“…In a reported series of 29 eyes with treated Rb undergoing cataract surgery by Kaliki et al ,1 only one eye had IVitC-induced cataract. More recently, Koç et al 11 have reported a series of five eyes of five patients with Rb who developed cataracts secondary to IVitC and subsequently underwent clear corneal lensectomy and anterior vitrectomy with or without an IOL implant. These patients also received intravitreal melphalan or topotecan intraoperatively as prophylaxis against possible tumour dissemination and subsequently received repeat monthly injections as required.…”