Chorioretinal Vascular Side Effects of Intra-Arterial Chemotherapy for Retinoblastoma

For patients with retinoblastoma, the use of intra-arterial chemotherapy (IAC) can induce retinal and choroidal vascular hyperfusion, according to a study presented by Jose J Echegaray, MD at the 37^th ASRS Annual Meeting.

Retinoblastoma treatment with IAC is associated with effective local control rates but can also lead to vascular toxicity in the retina and choroid. In this study, the researchers sought to discern the choroidal and retinal vascular side effects of IAC for intraocular retinoblastoma evaluated by fluorescein angiography (FA). In this single-institution, retrospective case series, the researchers examined 13 eyes of 10 consecutive patients undergoing retinoblastoma treatment with IAC between January and December of 2018. The evaluated eyes were classified as group C (two cases, 15%), group D (eight cases, 62%) and group E (three cases, 23%). The chemotherapy regimens of these patients comprised melphalan, carboplatin, and/or topotecan. The researchers analyzed fluorescein angiography studies for the presence of retinal choroidal, and optic disc vascular hyperfluorence, as well as well hypofluorescence, leakage, telangiectasia, and neovascularization. Key endpoints of this study were differentiated using the Fisher’s exact test.

According to the study results, the average number of IAC infusions was three per eye, and FA characteristics included choroidal hypoperfusion in 10 (77%), retinal hypoperfusion in 8 (62%), retinal capillary leakage in 7 (54%), disc hyperfluorescence in 7 (54%), retinal telangiectasia in 4 (31%), retinal neovascularization in 2 (15%), and disc leakage in 1 (8%) eyes. The researchers observed retinal and choroidal hypoperfusion in almost 90% of eyes treated with all three agents juxtaposed to 33% of eyes treated with carboplatin plus topotecan (P=0.05). Tumor regression was achieved in 100% of eyes.

In their conclusion, the authors noted that “further studies will be required to determine the long-term visual and ocular implications of these findings and how they should inform treatment decisions.”

Echegaray J. Chorioretinal Vascular Side Effects of Intra-Aterial Chemotherapy for Retinoblastoma. Presented at the 37^th ASRS Annual Meeting; July 26-30, 2019; Chicago, IL.

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