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Retinoblastoma: Intravitreal Chemotherapy

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Clinical Ophthalmic Oncology

Abstract

Vitreous seeding in retinoblastoma was for long recognized as a major risk factor for eye survival, due to the hypoxic environment of the vitreous and the reduced vitreous concentration of the drugs when delivered intravenously, intra-arterially, and/or periocularly. In 2012, the establishment of a safe technique for intravitreal melphalan injection helped to overcome this problem and became rapidly adopted worldwide. So where do we stand now? First, recent studies have now confirmed long-term intravitreal chemotherapy safety and efficacy, for both persistent and recurrent vitreous disease. Reported experience from various centers has also shown that intravitreal chemotherapy not only reduced the enucleation rate but also contributed to eradicate the need for external beam irradiation, improving undeniably the quality of life of the patients. On the other hand, clinical observations and a better knowledge of the cellular composition of the seeding helped us to reevaluate the treatment response and redefine the treatment intensity according to the seed classification. Finally, as more advanced eyes are now salvaged, increasing efforts are made to control or minimize intraocular treatment-related toxicity and preserve vision. Intravitreal topotecan has recently demonstrated efficacy and lower retinal toxicity. Future studies will determine if topotecan as monotherapy could supplant melphalan for the vitreous disease.

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, Jules-Gonin Eye Hospital, University of Lausanne, Lausanne, Vaud, Switzerland

    Christina Stathopoulos & Francis L. Munier

Authors
  1. Christina Stathopoulos
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  2. Francis L. Munier
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Corresponding author

Correspondence to Francis L. Munier .

Editor information

Editors and Affiliations

  1. Associate Professor of Ophthalmology, Children’s Hospital Los Angeles, The USC Roski Eye Institute Keck School of Medicine, Los Angeles, CA, USA

    Jesse L. Berry

  2. Children’s Hospital Los Angeles, The USC Roski Eye Institute, Keck School of Medicine, Los Angeles, CA, USA

    Jonathan W. Kim

  3. University of Oxford, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK

    Bertil E. Damato

  4. Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA

    Arun D. Singh

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Stathopoulos, C., Munier, F.L. (2019). Retinoblastoma: Intravitreal Chemotherapy. In: Berry, J., Kim, J., Damato, B., Singh, A. (eds) Clinical Ophthalmic Oncology. Springer, Cham. https://doi.org/10.1007/978-3-030-11123-6_15

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  • DOI: https://doi.org/10.1007/978-3-030-11123-6_15

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-11122-9

  • Online ISBN: 978-3-030-11123-6

  • eBook Packages: MedicineMedicine (R0)

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