Intravitreal Melphalan versus Topotecan for Vitreous Seeds in Retinoblastoma: A Comparative Study of 64 Asian Indian Eyes.

IF 4.4 Q1 OPHTHALMOLOGY

Ophthalmology. Retina Pub Date : 2024-11-19 DOI:10.1016/j.oret.2024.11.010

Ayushi Agarwal, Vishakha Tanna, Vijitha S Vempuluru, Vishal Raval, Swathi Kaliki

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Abstract

Purpose: To compare the outcomes of intravitreal melphalan (IVit-M) versus intravitreal topotecan (IVit-T) for vitreous seeds (VS) in retinoblastoma (RB).

Design: Retrospective interventional study.

Participants: Patients of RB with VS receiving intravitreal chemotherapy (IVit-C) between December 2012 and December 2022, at a single quaternary ocular oncology referral center.

Intervention: Intravitreal melphalan injection of 25 μg/0.1 mL in 25 eyes and IVit-T of 30 μg/0.15 mL in 39 eyes.

Main outcome measures: Resolution of VS, globe salvage, IVit-C-related complications.

Results: The mean age at presentation was 28 months (median, 24 months; range, 4-144 months) for the IVit-M group and 25 months (median, 24 months; range, 2-60 months) for the IVit-T group. At the time of initiation of intravitreal injection, the VS belonged to type 1 (1 [4%] vs. 1 [3%]), type 2 (9 [36%] vs. 14 [36%]), type 3 (8 [32%] vs. 18 [46%]), or a combination of these (7 [28%] vs. 6 [15%]) in IVit-M and IVit-T groups, respectively. Complete resolution of VS after IVit-C was seen in 22 (92%) and 28 (72%) eyes (P = 0.069) in IVit-M and IVit-T groups, respectively. At a mean follow-up period of 44 months after the first IVit-C injection in the IVit-M group and 19 months in the IVit-T group, globe salvage was higher in the IVit-T group (77%) than in the IVit-M group (60%, P = 0.148), respectively. Posterior segment complications were significantly higher in the IVit-M group than in the IVit-T group (P < 0.001). These included retinal pigment epithelial atrophy (P < 0.001), optic atrophy (P < 0.001), vascular attenuation (P < 0.001), and retinal/subretinal hemorrhages (P = 0.004).

Conclusions: Intravitreal topotecan is as efficacious as IVit-M for controlling VS in RB, with a better safety profile in pigmented Asian Indian eyes.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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玻璃体内美法仑与托泊替康治疗视网膜母细胞瘤玻璃体种子：64 只亚洲印度眼的比较研究。

目的：比较玻璃体内美法仑（IVit-M）与玻璃体内托泊替康（IVit-T）治疗视网膜母细胞瘤（RB）玻璃体种子（VS）的疗效：研究设计：回顾性干预研究：2012年12月至2022年12月期间在一家四级眼肿瘤转诊中心接受玻璃体内化疗的视网膜母细胞瘤患者：干预措施：25只眼睛接受25mcg/0.1cc的IVit-M注射，39只眼睛接受30mcg/0.15cc的IVit-T注射：结果：VS缓解、眼球挽救、玻璃体内化疗相关并发症结果：IVit-M组患者的平均发病年龄为28个月（中位数为24个月；范围为4至144个月），IVit-T组患者的平均发病年龄为25个月（中位数为24个月；范围为2至60个月）。在开始进行玻璃体内注射时，IVit-M 组和 IVit-T 组的 VS 分别属于 1 型（1 (4%) vs. 1 (3%)）、2 型（9 (36%) vs. 14 (36%)）、3 型（8 (32%) vs. 18 (46%)）或这些类型的组合（7 (28%) vs. 6 (15%)）。IVit-M 组和 IVit-T 组分别有 22 只（92%）和 28 只（72%）眼球在玻璃体内化疗后 VS 完全消退（P=0.069）。在 IVit-M 组和 IVit-T 组首次注射 IVit-C 后平均 44 个月和 19 个月的随访期间，IVit-T 组的球状体挽救率（77%）分别高于 IVit-M 组（60%，P=0.148）。IVit-M组的后节段并发症明显高于IVit-T组（P结论：IVit-T与IVit-M在控制RB的VS方面具有同样的疗效，而且在色素沉着的亚洲印度人眼中具有更好的安全性。

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