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. 2019 Jun;5(4):238-244.
doi: 10.1159/000493687. Epub 2018 Nov 2.

Posterior Vitreous Detachment and the Associated Risk of Retinal Toxicity with Intravitreal Melphalan Treatment for Retinoblastoma

Jesse L Berry  1   2 , Ramon Lee  1   2 , Luv Patel  1   2 , Bao Han A Le  1   2 , John O'Fee  1   2 , Rima Jubran  3 , Jonathan W Kim  1   2
Affiliations

Posterior Vitreous Detachment and the Associated Risk of Retinal Toxicity with Intravitreal Melphalan Treatment for Retinoblastoma

Jesse L Berry et al. Ocul Oncol Pathol. 2019 Jun.

Abstract

Background/aims: The presence of a posterior vitreous detachment (PVD) may play a role in the development of severe retinal toxicity following intravitreal melphalan (IVM) injection for vitreous seeding. We aimed to evaluate the incidence of PVD in retinoblastoma eyes and its association with retinal toxicity after IVM.

Methods: We reviewed 112 eyes of 81 retinoblastoma patients with B-scan images available for review from 2010 to 2017. A cohort with vitreous seeding treated with IVM was compared to a cohort that did not undergo injection. The primary outcome measure was the presence of PVD at diagnosis and after treatment. Secondary measures included IVM-associated retinal toxicity and other ocular complications.

Results: The incidence of PVD was 20% at diagnosis, and in eyes with B-scans available both at diagnosis and after treatment 18% of eyes developed a PVD over the course of therapy, more frequently after IVM (p = 0.05). Of 34 eyes receiving IVM treatment, the incidences of posterior segment toxicity and globe salvage were similar between eyes with and without PVD (p = 0.4015 and 0.52, respectively).

Conclusion: In this cohort of patients, there did not appear to be an association with the presence of PVD during IVM and the development of retinal toxicity.

Keywords: Posterior segment; Retinoblastoma; Toxicity.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Patient with retinoblastoma and with posterior vitreous detachment (PVD) prior to intravitreal melphalan (IVM) treatment who developed Grade 5 retinal toxicity after one 20 μg IVM injection. a Fundus photography of retinoblastoma at diagnosis (far left), prior to IVM (left), 1 week after IVM (right), and 6 weeks after IVM (far right). Extensive hemorrhagic retinal toxicity is noted 1 week after IVM (right), which progressed to Grade 5 toxicity with extensive retinal pigment epithelium hyperplasia involving the fundus and mild optic nerve pallor (far right). Electroretinogram evaluation showed a flat recording. b B-scan ultrasonography of the eye at diagnosis was graded as indeterminate; however, a PVD is likely present (left, PVD marked with arrow); prior to IVM the PVD is visualized (middle, PVD marked with arrow). After IVM at the time of acute hemorrhagic toxicity, there is extensive retinal swelling and shallow retinal detachment (asterisk) with a PVD (right, PVD marked with arrow).
Fig. 2
Fig. 2
Patient with retinoblastoma and without posterior vitreous detachment (PVD) prior to intravitreal melphalan (IVM) treatment who developed Grade 4 retinal toxicity after IVM. a Fundus photography of retinoblastoma at diagnosis (left), prior to IVM (middle), and after IVM (right). Grade 4 retinal toxicity with maculopathy is noted after IVM (right). b B-scan ultrasonography of the eye at diagnosis (left), prior to IVM (middle), and after IVM (right). The absence of PVD is noted prior to and after IVM. The demonstrated maculopathy did not resolve.
See this image and copyright information in PMC

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