{"title":"Intravitreal Melphalan versus Topotecan for Vitreous Seeds in Retinoblastoma: A Comparative Study of 64 Asian Indian Eyes.","authors":"Ayushi Agarwal, Vishakha Tanna, Vijitha S Vempuluru, Vishal Raval, Swathi Kaliki","doi":"10.1016/j.oret.2024.11.010","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To compare the outcomes of intravitreal melphalan (IVit-M) versus intravitreal topotecan (IVit-T) for vitreous seeds (VS) in retinoblastoma (RB).</p><p><strong>Design: </strong>Retrospective interventional study.</p><p><strong>Participants: </strong>Patients of RB with VS receiving intravitreal chemotherapy (IVit-C) between December 2012 and December 2022, at a single quaternary ocular oncology referral center.</p><p><strong>Intervention: </strong>Intravitreal melphalan injection of 25 μg/0.1 mL in 25 eyes and IVit-T of 30 μg/0.15 mL in 39 eyes.</p><p><strong>Main outcome measures: </strong>Resolution of VS, globe salvage, IVit-C-related complications.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>Intravitreal topotecan is as efficacious as IVit-M for controlling VS in RB, with a better safety profile in pigmented Asian Indian eyes.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":4.4000,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Ophthalmology. Retina","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.oret.2024.11.010","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
引用次数: 0
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.