Case #59 – Retinoblastoma-Intravitreal Chemotherapy+Laser

Case #59 – Retinoblastoma-Intravitreal Chemotherapy+Laser – Page 9 of 9

About the Authors: David H Abramson, MD, FACS Dr. Abramson is a board-certified ophthalmologist with specialty training in ophthalmic oncology and is the Chief of the Ophthalmic Oncology Service at Memorial Sloan Kettering Cancer Center. He treats patients with intraocular tumors such as: uveal melanoma and retinoblastoma and our patients have access to

Case #59 – Retinoblastoma-Intravitreal Chemotherapy+Laser – Page 9 of 92021-07-21T05:10:59+00:00

Case #59 – Retinoblastoma-Intravitreal Chemotherapy+Laser – Page 8 of 9

About the Authors:Jasmine H Francis, MD, FACSDr. Francis is a board-certified ophthalmologist with specialty training in ophthalmic oncology and is an Associate Attending at Memorial Sloan Kettering Cancer Center. She sees patients with intraocular cancers such as uveal melanoma, lymphoma and retinoblastoma. She also participates in an interdisciplinary effort at Memorial Sloan Kettering to treat

Case #59 – Retinoblastoma-Intravitreal Chemotherapy+Laser – Page 8 of 92021-07-21T05:10:49+00:00

Case #59 – Retinoblastoma-Intravitreal Chemotherapy+Laser – Page 7 of 9

About the Authors:Julia Canestraro, OD, FAAOInstructor, Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer CenterDr. Canestraro is an Instructor at Memorial Sloan Kettering Cancer Center, Ophthalmic Oncology Service. She has experience in the diagnosis and non-surgical management of ocular disease, including ocular tumors. She also specializes in treating the ocular consequences of cancer and its treatments.

Case #59 – Retinoblastoma-Intravitreal Chemotherapy+Laser – Page 7 of 92021-07-21T05:10:38+00:00

Case #59 – Retinoblastoma-Intravitreal Chemotherapy+Laser – Page 6 of 9

ReferencesManjandavida FP, Shields CL. The role of intravitreal chemotherapy for retinoblastoma. Indian J Ophthalmol. 2015;63(2):141-145.Abramson DH, Ji X, Francis JH, Catalanotti F, Brodie SE, Habib L. Intravitreal chemotherapy in retinoblastoma: expanded use beyond intravitreal seeds. Br J Ophthalmol. 2019;103(4):488-493.Raval V, Bowen C, Soto H, Singh A. Chemotherapy for Retinoblastoma: Impact of Intravitreal Chemotherapy. Asia Pac

Case #59 – Retinoblastoma-Intravitreal Chemotherapy+Laser – Page 6 of 92021-07-21T05:10:24+00:00

Case #59 – Retinoblastoma-Intravitreal Chemotherapy+Laser – Page 5 of 9

OAC was introduced more than 10 years ago and has been shown to be effective in treating retinoblastoma.5 The majority of recurrences happen within the first year following the completion of OAC and eyes that receive drug via non-ophthalmic artery routes are more likely to recur.5 In this case, we inherited this patient after completing

Case #59 – Retinoblastoma-Intravitreal Chemotherapy+Laser – Page 5 of 92021-07-21T05:10:06+00:00

Case #59 – Retinoblastoma-Intravitreal Chemotherapy+Laser – Page 4 of 9

The right eye with completely regressed tumors at 3, 6 o’clock and adjacent to the optic nerve with remaining chorioretinal scarring, after 3 rounds of IVitC + laser. Intravenous chemotherapy (IVC) often includes the standard 3-drug regimen of vincristine, etoposide and carboplatin. When initially introduced, the main goal of IVC was to decrease

Case #59 – Retinoblastoma-Intravitreal Chemotherapy+Laser – Page 4 of 92021-07-21T05:13:33+00:00

Case #59 – Retinoblastoma-Intravitreal Chemotherapy+Laser – Page 3 of 9

What we did next: C. Intravitreal chemotherapy + laser Discussion:Intravitreal chemotherapy (IVitC) offers a localized treatment approach for recurrent intraocular tumors that is refractory to OAC. Traditionally, IVitC has been used to treat intravitreal seeds1 however recent use of IVitC for indications other than vitreous seeds has shown to be successful.2  IVitC avoids the time

Case #59 – Retinoblastoma-Intravitreal Chemotherapy+Laser – Page 3 of 92021-07-21T05:09:29+00:00

Case #59 – Retinoblastoma-Intravitreal Chemotherapy+Laser – Page 2 of 9

A magnified image of the tumor adjacent to the optic nerve at follow-up #3 What treatment intervention would be best going forward? A. Intravenous chemotherapy B. Ophthalmic artery chemosurgery C. Intravitreal chemotherapy + laser D. Enucleation

Case #59 – Retinoblastoma-Intravitreal Chemotherapy+Laser – Page 2 of 92021-07-21T05:08:51+00:00

Case #59 – Retinoblastoma-Intravitreal Chemotherapy+Laser – Page 1 of 9

Plan:The two tumors at 3 and 6 o’clock were treated with laser photocoagulation and the tumor near the optic nerve was treated with diode laser after injecting intravenous indocyanine green to enhance absorption (ICG). This was done on 2 separate occasions.Follow-up:The tumors at 3 and 6 o’clock responded well to laser treatment but the active

Case #59 – Retinoblastoma-Intravitreal Chemotherapy+Laser – Page 1 of 92021-07-21T05:08:34+00:00

Case #59 – Retinoblastoma-Intravitreal Chemotherapy+Laser – Page 0 of 9

Case A 26 month old male presented to our clinic with a history of bilateral retinoblastoma, diagnosed 5 months prior.Medical History: Negative. MRI of brain/orbits was performed without extraocular extension or brain metastasis.Past Treatment history at outside institution:4 rounds of systemic chemotherapy with vincristine, etoposide and carboplatin1 round of ophthalmic artery chemosurgery (OAC) with 4mg

Case #59 – Retinoblastoma-Intravitreal Chemotherapy+Laser – Page 0 of 92021-07-21T05:08:17+00:00