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Technique of Ophthalmic Artery Chemosurgery for Retinoblastoma

Chapter
Part of the Essentials in Ophthalmology book series (ESSENTIALS)

Abstract

Intra-arterial chemotherapy (IAC) has become an essential technique in the treatment of advanced intra-ocular retinoblastoma. In this chapter, we describe our experience with 1000 intra-arterial infusions for treating 290 eyes with retinoblastoma in 229 children, median age 15 month. According to the Reese-Ellsworth classification, 83 % eyes were Group V; according to the International classification, 70 % eyes were Group D and 13 % eyes were Group E. Catheterizations were successful in 98.8 %. The average number of IACs per eye was 3.4 (range 1–9). Three IAC techniques were used: direct ophthalmic artery infusion (77 %), infusion through the orbital branch of the middle meningeal artery (8 %), and balloon-assisted intracarotid infusion (14 %). The drug(s) were dosed according to age (which provides an estimate of the ocular size) and the angioanatomy of the ophthalmic artery and its branches. Body weight was taken into account only for limiting the total systemic dose. Three drugs were used: melphalan, topotecan, and carboplatin, usually in association. There were few complications. One patient died from a trilateral retinoblastoma, two patients who developed metastasis were treated with intensive chemotherapy and are doing well. The Kaplan–Meyer estimate of ocular survival was 85 % at 2 years, 77 % at 5 years, and 71 % at 7 years. In conclusion, IAC is a safe and effective technique that is used as first line therapy for advanced intra-ocular retinoblastoma.

Keywords

Internal Carotid Artery Retinal Vein Occlusion Ophthalmic Artery Lung Compliance Middle Meningeal Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Compliance with Ethical Requirements

Y. Pierre Gobin declares that he has no conflict of interest.

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Department of NeurosurgeryWeill Cornell Medical College, New York Presbyterian HospitalNew YorkUSA

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