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Electroretinogram Monitoring of Retinoblastoma Treatment

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

Abstract

Background: We report the results of electroretinogram monitoring of visual function in patients treated for retinoblastoma at the Ocular Oncology Clinic at MSKCC since 2006, mostly with intra-arterial chemotherapy infusion. Our experience to date exceeds 5300 ERG studies.

Methods: ERGs are recorded during examination under anesthesia using an ERG-jet contact lens electrode, with a hand-held ColorBurst ganzfeld stimulator. ERGs obtained under sevoflurane general anesthesia show a wandering baseline, which we have traced to slow waves generated in the brain, which are disinhibited by the anesthetic. These are suppressed by averaging the waveforms, usually in groups of 10.

Results: ERG waveforms under general anesthesia show greater variability than those seen in awake patients. Ocular manipulation, such as scleral depression and cryotherapy, reduces the ERG amplitudes. Accordingly, we obtain ERG recordings as the first procedure after anesthesia induction. A very high correlation exists between photopic (light-adapted) ERG responses and scotopic (dark-adapted) responses in these patients. At the 3-month visit after successful completion of intra-arterial treatment, of 215 eyes, ERGs were worse in 25.6 %, same in 58.1 %, and improved in 16.3 %. Three years after completion of treatment, compared with the 3-month time point, ERGs from 33 eyes were worse: 21.2 %; same: 57.6 %; better: 21.2 %. The threshold for retinal toxicity of intra-arterial melphalan appears to lie between a cumulative dose of 14 and 20 mg. Treatment with intravitreal injections of melphalan results in an estimated decrement of 5 μV of photopic ERG amplitude with each intravitreal injection of 30 μg of the drug.

Keywords

Intravitreal Injection Visual Evoke Potential Retinal Function Retinoblastoma Patient Scotopic Response 
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

Scott E. Brodie 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.

References

  1. 1.
    Ellsworth RM. The practical management of retinoblastoma. Trans Am Ophthalmol Soc. 1969;67:462–534.PubMedCentralPubMedGoogle Scholar
  2. 2.
    Gobin YP, Dunkel IJ, Marr BP, Brodie SE, Abramson DH. Intra-arterial chemotherapy for the management of retinoblastoma: four-year experience. Arch Ophthalmol. 2011;129(6):732–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Brodie SE, Munier FL, Francis JH, Marr B, Gobin YP, Abramson DH. Persistence of retinal function after intravitreal melphalan injection for retinoblastoma. Doc Ophthalmol. 2013;126(1):79–84.CrossRefPubMedGoogle Scholar
  4. 4.
    Abramson DH, Dunkel IJ, Brodie SE, Kim JW, Gobin YP. A phase I/II study of direct intraarterial (ophthalmic artery) chemotherapy with melphalan for intraocular retinoblastoma initial results. Ophthalmology. 2008;115(8):1398–404.CrossRefPubMedGoogle Scholar
  5. 5.
    Dunkel IJ, Shi W, Salvaggio K, Marr BP, Brodie SE, Gobin YP, Abramson DH. Risk factors for severe neutropenia following intra-arterial chemotherapy for intra-ocular retinoblastoma. PLoS One. 2014;9:10.CrossRefGoogle Scholar
  6. 6.
    Marmor MF, Fulton AB, Holder GE, Miyake Y, Brigell M. Bach M ISCEV standard for full-field clinical electroretinography (2008 update); International Society for Clinical Electrophysiology of Vision. Doc Ophthalmol. 2009;118(1):69–77.CrossRefPubMedGoogle Scholar
  7. 7.
    Francis JH, Abramson DH, Marr BP, Brodie SE. Ocular manipulation reduces both ipsilateral and contralateral electroretinograms. Doc Ophthalmol. 2013;127(2):113–22.CrossRefPubMedGoogle Scholar
  8. 8.
    Cameron AM, Marhoo OA, Lamb TD. Dark adaptation of human rod bipolar cells measured from the b-wave of the scotopoic electroretinogram. J Physiol. 2006;575(Pt 2):507–26.CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Mahroo OA, Lamb TD. Recovery of the human photopic electroretinogram after bleaching exposures: estimation of pigment regeneration kinetics. J Physiol. 2004;554(Pt 2):417–37.CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Liu CY, Jonna G, Francis JH, Marr BP, Abramson DH, Brodie SE. Non-selectivity of ERG reductions in eyes treated for retinoblastoma. Doc Ophthalmol. 2014;128(1):13–23.CrossRefPubMedGoogle Scholar
  11. 11.
    Abramson DH, Dunkel IJ, Brodie SE, Marr B, Gobin YP. Superselective ophthalmic artery chemotherapy as primary treatment for retinoblastoma (chemosurgery). Ophthalmology. 2010;117(8):1623–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Abramson DH, Marr BP, Brodie SE, Dunkel I, Palioura S, Gobin YP. Ophthalmic artery chemosurgery for less advanced intraocular retinoblastoma: five year review. PLoS One. 2012;7(4), e34120.CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Palioura S, Gobin YP, Brodie SE, Marr BP, Dunkel IJ, Abramson DH. Ophthalmic artery chemosurgery for the management of retinoblastoma in eyes with extensive (>50%) retinal detachment. Pediatr Blood Cancer. 2012;59(5):859–64.CrossRefPubMedGoogle Scholar
  14. 14.
    Francis JH, Abramson DH, Gobin YP, Marr BP, Dunkel IJ, Riedel ER, et al. Electroretinogram monitoring of dose-dependent toxicity after ophthalmic artery chemosurgery in retinoblastoma eyes: six year review. PLoS One. 2014a;9(1), e84247.CrossRefPubMedCentralPubMedGoogle Scholar
  15. 15.
    Munier FL, Gaillard M-C, Balmer A, Soliman S, Podilsky G, Moulin AP, et al. Intravitreal chemotherapy for vitreous disease in retinoblastoma revisited: from prohibition to conditional indications. Br J Ophthalmol. 2012;96(8):1078–83.CrossRefPubMedGoogle Scholar
  16. 16.
    Kaneko A, Suzuki S. Eye-preservation treatment of retinoblastoma with vitreous seeding. Jpn J Clin Oncol. 2003;33(12):601–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Brodie SE, Pierre Gobin Y, Dunkel IJ, Kim JW, Abramson DH. Persistence of retinal function after selective ophthalmic artery chemotherapy infusion for retinoblastoma. Doc Ophthalmol. 2009;119(1):13–22.CrossRefPubMedGoogle Scholar
  18. 18.
    Francis JH, Schaiquevich P, Buitrago E, Del Sole MJ, Zapata G, Croxatto JO, et al. Local and systemic toxicity of Intravitreal melphalan for vitreous seeding in retinoblastoma: a preclinical and clinical study. Ophthalmology. 2014b;121(9):1810–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Gobin YP, Dunkel IJ, Marr BP, Francis JH, Brodie SE, Abramson DH. Combined, sequential intravenous and intra-arterial chemotherapy (bridge chemotherapy) for young infants with retinoblastoma. PLoS One. 2012;7(9), e44322.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Department of OphthalmologyIcahn School of Medicine at Mount SinaiNew YorkUSA

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