Risk of Extraocular Extension in Eyes With Retinoblastoma Receiving Intravitreous Chemotherapy

Risk of Extraocular Extension in Eyes With Retinoblastoma Receiving Intravitreous Chemotherapy

Author Francis, Jasmine H. Google Scholar
Abramson, David H. Google Scholar
Ji, Xunda Google Scholar
Shields, Carol L. Google Scholar
Teixeira, Luiz F. Autor UNIFESP Google Scholar
Schefler, Amy C. Google Scholar
Cassoux, Nathalie Google Scholar
Hadjistilianou, Doris Google Scholar
Berry, Jesse L. Google Scholar
Frenkel, Shahar Google Scholar
Munier, Francis L. Google Scholar
Abstract IMPORTANCE The risk of extraocular extension from injecting chemotherapy into eyes with retinoblastoma is minimally understood; however, understanding this risk is important because of the increasing use of intravitreous chemotherapy. OBJECTIVE To evaluate the risk of extraocular extension in eyes with retinoblastoma that have received intravitreous chemotherapy injections. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was performed in 655 patients at 10 retinoblastoma centers in North and South American, European, Israeli, and Chinese centers. Physicians at the retinoblastoma centers administered more than 120 intravitreous chemotherapy injections in eyes with retinoblastoma from February 1, 1999, through February 28, 2017. MAIN OUTCOMES AND MEASURES Risk of extraocular extension with secondary observational variables, including injection and precautionary techniques. RESULTS A total of 3553 intravitreous chemotherapy injections (3201 melphalan hydrochloride, 335 topotecan hydrochloride, and 17 methotrexate sodium) were administered to 704 eyes in 655 patients with retinoblastoma (mean [SD] age of patients at the time of the initial injections, 31.6 [11.6] months; 348 male [53.1%]). There were no extraocular tumor events related to prior intravitreous injections. This finding resulted in a calculated proportion of zero extraocular events per eye. According to the rule of 3, the risk is no greater than 0.08% injections. All 10 centers included in this study used at least 2 presumed precautionary injection methods (lowering of intraocular pressure, cryotherapy, ocular surface irrigation, ultrasonic biomicroscopy surveillance of the injection site, and subconjunctival chemotherapy deposition). CONCLUSIONS AND RELEVANCE With use of at least 2 presumed precautionary safety methods, no extraocular extension of tumor events occurred. According to the rule of 3, this finding suggests that the risk is no greater than 0.08% injections.
xmlui.dri2xhtml.METS-1.0.item-coverage Chicago
Language English
Sponsor Fund for Ophthalmic Knowledge
New York Community Trust
Research to Prevent Blindness
Cancer Center Support grant [P30 CA008748]
Date 2017
Published in Jama Ophthalmology. Chicago, v. 135, n. 12, p. 1426-1429, 2017.
ISSN 2168-6165 (Sherpa/Romeo, impact factor)
Publisher Amer Medical Assoc
Extent 1426-1429
Origin http://dx.doi.org/10.1001/jamaophthalmol.2017.4600
Access rights Closed access
Type Article
Web of Science ID WOS:000418056800029
URI https://repositorio.unifesp.br/handle/11600/58080

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