Further studies needed to assess safety, efficacy of superselective ophthalmic artery chemotherapy

Retina. 2011;31(3):566-573.

Superselective ophthalmic artery chemotherapy should be restricted to more advanced cases of retinoblastoma and should only be given in one eye, a study found.

"Because superselective ophthalmic artery chemotherapy is being considered as first-line or salvage therapy in a growing number of retinoblastoma referral centers around the world, one has to recognize that its systemic and ocular adverse effects remain poorly described," the study authors wrote.

The retrospective study assessed 13 patients who received intraarterial chemotherapy as an alternative to enucleation or external beam radiotherapy, using fundus photography and fluorescein angiography to monitor ocular status at presentation and each follow-up exam. Mean follow-up was 7 months.

No stroke or significant systemic side effects occurred, aside from a perioperative spasm of the internal carotid artery in one eye. Two eyes experienced a temporary sectoral choroidal occlusive vasculopathy leading to chorioretinal atrophy. According to the study authors, the underlying pathogenic mechanism of this complication remains unclear but does not appear to be dose dependent.

One eye also suffered from retinal arteriolar emboli, and this complication was associated with a prolonged, difficult cannulation of the ophthalmic artery. Visual results ranged from 20/1600 to 20/32, correlating closely with tumor localization and status of the fellow eye.

The sight- and life-threatening nature of the observed complications suggests the need for a multicentric phase 2 clinical trial further assessing superselective ophthalmic artery chemotherapy, the study authors wrote.