This study aimed to describe the relationship between intravitreal chemotherapy and IOP in children with retinoblastoma and identify risk factors for pronounced elevations. This was a retrospective study of ten cases (ten eyes) with 17 encounters overall. Mean age was 33.6±9.4months. Mean IOP immediately after first injection was 45.4±14.3mmHg with a mean increase from baseline of 36.9±13.7. This reduced to <29mmHg in a mean of 153.3±97.5 seconds in 89.5% of cases. Mean IOP immediately after the second injection was 44.5±11 with a mean increase of 18.2±10.5 and reducing to 31±5mmHg by 150 seconds. Other than pre-injection digital massage, no patient needed further treatment to lower IOP. This study confirms a transient but substantial increase in IOP following intravitreal injection. The results indicate that the second injection can likely be safely given approximately three to five minutes after the first injection. There is a risk of CRAO when IOP exceeds the arterial perfusion pressure. This was exceeded in four cases but reduced in approximately one minute or less. Further research is warranted to determine if these acute elevations are of clinical significance. 

Intraocular pressure changes following intravitreal Melphalon and Topotecan for the treatment of retinoblastoma with vitreous seeding.
Karl MD, Francis JH, Iyer SI, et al.
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Fiona Rowe (Prof)

Institute of Population Health, University of Liverpool, UK.

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