Reduction of severe visual loss and complications following IAC for RB
Reviewed by Jonathan Chan

This was a retrospective cohort study of patients with retinoblastoma (RB) who required intra-arterial chemotherapy (IAC) between 2013 and 2015, who had relapsed following systemic chemotherapy. A total of nine patients were included in the study and their ocular complications were determined using vision, macula including pattern reversal visual evoked potentials (PVEPs), electroretinograms (ERGs) and ocular motility functions. The doses of IAC treatment with Melphalan +/- Topotecan used and catheterisation complications were also assessed. The efficacy of IAC treatment was also assessed; 6/9 had severe autonomic physiological reactions requiring adrenaline during catheterisation; 7/27 catheterisation of the ophthalmic artery was difficult. The mean follow-up was 20.9 months, range 3.7-35.2 months, and no child suffered any severe visual loss. Eight children had PVEPs post IAC and were reported normal and all had normal post IAC ERGs except one child (total dose of 20mg Melphalan and 0.8mg Topotecan). One child developed nasal choroidal ischaemia and a sixth nerve palsy; 6/9 patients achieved tumour control after IAC treatment. The authors concluded that dose is the most important factor for ocular injury and may be reduced by age- adjusted doses of Melphalan.

Reduction of severe visual loss and complications following intra-arterial chemotherapy (IAC) for refractory retinoblastoma.
Reddy MA, Naeem Z, Duncan C, et al.
BRITISH JOURNAL OF OPHTHALMOLOGY
2017;101:1704-8.