Managing the consequences of aggressive conservative treatment for refractory retinoblastoma with vitreous seeding

Aubrey Brink, Zelia Correa, James Geller, Todd Abruzzo, James J. Augsburger

Research output: Contribution to journalArticle

Abstract

A 4 year-old girl with bilateral, non-familial retinoblastoma (RB) was referred to our care after primary enucleation OS and active tumor OD refractory to multiple therapies (intravenous chemotherapy, laser/cryotherapy, and I-125 plaque radiotherapy). Vitreous seeding OD, initially controlled by several sessions of Ophthalmic Artery Infusion Chemotherapy (OAIC) and periocular chemotherapy, recurred shortly thereafter. The patient underwent intravitreal (IVit) Melphalan injections achieving tumor control despite the concurrent development of keratopathy, pupillary synechiae, cataract, and necrosis of the inferior fornix and the adjacent orbital fat, all secondary to the treatments administered. Repeated amniotic membrane implants and tarsorrhaphy were performed to alleviate the symptoms. Despite being tumor free for 6 months, a poor fundus view and treatment-related complications prompted us to consider enucleation, but parents declined. Following recent negative magnetic resonance imaging (MRI), her cataract was removed. She was then found to have tumor recurrence. Her eye was enucleated 12 months ago and she recovered well from the surgery. As ocular oncology embarks in eye-preserving treatments for retinoblastoma, it is important to address the cumulative effects and associated impact of such treatments and the possibility of failure.

Original languageEnglish (US)
Pages (from-to)256-258
Number of pages3
JournalArquivos Brasileiros de Oftalmologia
Volume77
Issue number4
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Retinoblastoma
Drug Therapy
Cataract
Neoplasms
Ophthalmic Artery
Intravitreal Injections
Cryotherapy
Amnion
Melphalan
Therapeutics
Treatment Failure
Primary Health Care
Lasers
Necrosis
Radiotherapy
Parents
Fats
Magnetic Resonance Imaging
Recurrence
Conservative Treatment

Keywords

  • Case reports
  • Child
  • Eye enucleation
  • Female
  • Humans
  • Intravitreal injections
  • Melphalan/ administration &dosage
  • Retinal neoplasms/surgery
  • Retinoblastoma/drug therapy
  • Retinoblastoma/surgery
  • Vitreous body/pathology

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Managing the consequences of aggressive conservative treatment for refractory retinoblastoma with vitreous seeding. / Brink, Aubrey; Correa, Zelia; Geller, James; Abruzzo, Todd; Augsburger, James J.

In: Arquivos Brasileiros de Oftalmologia, Vol. 77, No. 4, 01.01.2014, p. 256-258.

Research output: Contribution to journalArticle

Brink, Aubrey ; Correa, Zelia ; Geller, James ; Abruzzo, Todd ; Augsburger, James J. / Managing the consequences of aggressive conservative treatment for refractory retinoblastoma with vitreous seeding. In: Arquivos Brasileiros de Oftalmologia. 2014 ; Vol. 77, No. 4. pp. 256-258.
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