Electroretinogram Monitoring of Retinoblastoma Treatment
Part of the
Essentials in Ophthalmology
book series (ESSENTIALS)
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.
KeywordsIntravitreal Injection Visual Evoke Potential Retinal Function Retinoblastoma Patient Scotopic Response
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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.
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