Retinopathy in young retinoblastoma patients receiving a chemotherapy treatment: clinical trials and morphometric analysis

Ophthalmic Genet. 2019 Dec;40(6):521-533. doi: 10.1080/13816810.2019.1711427. Epub 2020 Jan 10.

Abstract

Background: This research is to evaluate patients with retinoblastoma, who receive chemotherapy, with enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) to compare the signs of retinopathy.Materials and Methods: A prospective non-randomized trial included 125 eyes of 74 patients at the age of 24 ± 1.6 months with retinoblastoma. All patients underwent an ophthalmoscopic examination and EDI-OCT before therapeutic treatment. The test group consisted of 55 patients, who underwent a course of chemotherapy. Patients were divided into two groups depending on the type of chemotherapy. Group #1 patients received six cycles of systemic intravenous chemotherapy treatment, ophthalmoscopic examination, and EDI-OCT occurred after third cycle and sixth cycle. Group #2 underwent three cycles of IVC chemotherapy treatment, and then local chemotherapy - three cycles of super-selective intra-arterial chemotherapy for exophytic retinoblastoma and 9 procedures of intravitreal (IVT) for endophytic retinoblastoma. Eyes in the control group were affected by eccentric neoplasms but macula and the optic nerve were not damaged.Results: After six cycles of IVC chemotherapy treatment, Group #1 history expanded with atrophy-induced peripapillary nerve fiber layer thinning (33.9%). At three cycle of super-selective intra-arterial chemotherapy, OCT imaging in Group #2 revealed more related symptoms like retinal vascular distention in peritumoral area. After systemic and intravitreal chemotherapy, macular puckers and small hyperreflective dotted foci in the inner retina were tracked. In Group #3 affected by peripheral tumors, the topographic anatomy of the macula was normal prior to therapy.Conclusion: Profound morphometric disturbances that come with combined chemotherapy call for a more careful treatment with methods selected in terms of OCT findings and specific chemotherapy contraindications.

Keywords: Retinoblastoma; intravitreal (IVT) chemotherapy; retinopathy; super-selective intra-arterial (IAC) chemotherapy; systemic intravenous (IVC) chemotherapy.

MeSH terms

  • Adult
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Case-Control Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Non-Randomized Controlled Trials as Topic
  • Prognosis
  • Prospective Studies
  • Retinal Diseases / chemically induced
  • Retinal Diseases / pathology*
  • Retinal Neoplasms / drug therapy*
  • Retinal Neoplasms / pathology
  • Retinoblastoma / drug therapy*
  • Retinoblastoma / pathology
  • Young Adult