Pathological findings in enucleated eyes after intravitreal melphalan injection

Ghassemi, Fariba; Amoli, Fahimeh Asadi

doi:10.1007/s10792-013-9851-2

Cited by 34 publications

(29 citation statements)

References 21 publications

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“…The use of intravitreal chemotherapy to control vitreous seeds — most difficult to control form of retinoblastoma — has been promising, especially in combination with a safety-enhanced injection technique and well defined eligibility criteria. 133,135,136,163,164 Under anaesthesia, the intraocular pressure is lowered by removing a small volume of fluid from the anterior chamber or by digital massage. Melphalan (or combined with topotecan) is injected into the vitreous behind the lens, through the conjunctival, sclera, and pars plana with a small-gauge needle.…”

Section: Managementmentioning

confidence: 99%

Retinoblastoma

Dimaras

Corson

Cobrinik

et al. 2015

Nat Rev Dis Primers

464

390

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Retinoblastoma is a rare cancer of the infant retina, which forms when both RB1 alleles mutate in a susceptible retinal cell, likely a cone photoreceptor precursor. Loss of the tumour suppressor functions of the retinoblastoma protein, pRB, leads to uncontrolled cell division and recurrent genomic changes during tumour progression. Although pRB is expressed in virtually all tissues, cone precursors have biochemical and molecular features that may sensitize to RB1 loss to enable tumourigenesis. Retinoblastoma is diagnosed in ~8,000 children each year worldwide. Patient survival is >95% in high-income countries, but <30% globally. However, outcomes are improving through increasing awareness for earlier diagnosis, new guidelines and sharing of expertise. Intra-arterial and intravitreal chemotherapy have emerged as promising methods to salvage eyes. Ongoing international collaborations will replace the multiple different classifications of eye involvement with standardized definitions to consistently assess eligibility, efficacy and safety of treatment options. Life-long follow-up is warranted since survivors of heritable retinoblastoma are at risk for developing second cancers. Defining the molecular consequences of RB1 loss in diverse tissues may open new avenues for treatment and prevention of retinoblastoma as well as second cancers in patients with germline RB1 mutations.

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Section: Managementmentioning

confidence: 99%

Retinoblastoma

Dimaras

Corson

Cobrinik

et al. 2015

Nat Rev Dis Primers

464

390

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“…Intravitreal melphalan injections directly bypass this barrier and achieve tumoricidal concentrations in the vitreous [4]. While highly effective, intravitreal melphalan injection may in rare cases be associated with serious ocular side effects [6,7]. The case series herein described presents the first examples of acute hemorrhagic retinal toxicity noted within 1 week of intravitreal melphalan injection, without any recognized deviation from the standard technique.…”

Section: Discussionmentioning

confidence: 99%

“…For example, Francis et al [3] demonstrated that weekly injections of melphalan resulted in a dose-dependent decrease in the electroretinogram (ERG) response in both humans and rabbits; thus, they cautioned against doses higher than 30 μg. Ghassemi and Amoli [6] described ischemic necrosis in the retina and choroid, severe gliosis and phthisis bulbi, and secondary neovascularization in a histopathologic analysis of enucleated eyes after receiving 50 μg of intravitreal melphalan. Severe toxicity after intravitreal melphalan injection appears to be rare.…”

Section: Introductionmentioning

confidence: 99%

Acute Hemorrhagic Retinopathy following Intravitreal Melphalan Injection for Retinoblastoma: A Report of Two Cases and Technical Modifications to Enhance the Prevention of Retinal Toxicity

et al. 2016

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Aims: To report the occurrence of acute hemorrhagic retinopathy following intravitreal melphalan injection for retinoblastoma. Methods: This is a retrospective case series of 2 patients with retinoblastoma treated with intravitreal melphalan for vitreous seeding who developed acute hemorrhagic retinopathy. Results: Patient 1 is a 6-month-old female with bilateral retinoblastoma (Group D right eye and Group B left eye) treated with 4 cycles of systemic chemotherapy and 2 intravitreal melphalan injections in each eye. Patient 2 is a 10-month-old male with unilateral Group D retinoblastoma treated with 6 cycles of systemic chemotherapy and 2 injections of intravitreal melphalan. At the 1-week follow-up after the second injection, both patients had an acute hemorrhagic retinopathy that resulted in chorioretinal toxicity with a sharp demarcation line between the normal and abnormal retina. At the last follow-up (22 and 12 months, respectively), there was total tumor control and resolution of vitreous seeding in both patients. Conclusions: Although intravitreal melphalan injection is effective for vitreous seeding in eyes with retinoblastoma, acute hemorrhagic retinopathy and diffuse chorioretinal atrophy is a possible complication of this treatment modality. Given the clinical findings observed in these patients, the development of this retinal toxicity most likely results from a retrohyaloid overdose. Consequently we suggest preventive measures aimed at limiting the risk of retrohyaloid injection.

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“…In another study, they showed that of 25 IViC-treated cases, eight eyes needed enucleation because of phthisis, parent request, or new tumor development. There was no case of needle-site scleral involvement by retinoblastoma cells 141,142…”

Section: Clinical Management Of Retinoblastomamentioning

confidence: 98%

Risk definition and management strategies in retinoblastoma: current perspectives

Ghassemi

Khodabande

2015

OPTH

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This manuscript focuses on high-risk factors of metastatic disease in retinoblastoma and evaluation of the current treatments of retinoblastoma. Presence of histopathologic high-risk factors is associated with a higher risk of local recurrence and systemic metastasis. Currently, globe-sparing therapies, including systemic chemotherapy, intra-arterial chemoreduction, intravitreal chemotherapy, focal consolidation, and combination therapies, are being used and investigated actively. Major advances are being made in the diagnosis and management of retinoblastoma that will lead to improved morbidity and mortality rates in patients with retinoblastoma. By saving the globes, fronting with some high-risk factors for metastasis would be inevitable. International multi-institutional prospective studies could resolve current uncertainties regarding the main tumor treatment regimens for each patient and indications for chemoprophylaxis for high-risk-factor-bearing retinoblastoma cases.

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Pathological findings in enucleated eyes after intravitreal melphalan injection

Cited by 34 publications

References 21 publications

Retinoblastoma

Retinoblastoma

Acute Hemorrhagic Retinopathy following Intravitreal Melphalan Injection for Retinoblastoma: A Report of Two Cases and Technical Modifications to Enhance the Prevention of Retinal Toxicity

Risk definition and management strategies in retinoblastoma: current perspectives

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