Selective ophthalmic arterial injection therapy for intraocular retinoblastoma: the long-term prognosis

Purpose: To report the success rate, adverse events, and long-term prognosis of selective ophthalmic arterial injection (SOAI) therapy for intraocular retinoblastoma.

Design: Noncomparative case series.

Participants: A total of 408 eyes of 343 patients.

Methods: Retrospective chart review of patients with intraocular retinoblastoma treated with SOAI using a balloon catheter and melphalan between 1988 and 2007.

Main outcome measures: The technical success rate of SOAI (we defined success as the successful injection of melphalan into the ophthalmic artery), ocular adverse events, systemic adverse events, secondary neoplasms, eye survival, and visual acuity.

Results: Selective ophthalmic arterial injection was successful in 1452 procedures of 1469 trials, and the success rate was 98.8%. Each eye received 1 to 18 rounds of SOAI. Two eyes (0.5%) developed severe orbital inflammation, and 2 eyes (0.5%) had diffuse chorioretinal atrophy. Transient periocular swelling or redness occurred in some cases. No severe systemic adverse events were detected. Transient bronchospasm occurred in 1 patient (0.3%), and transient vomiting occurred in several patients. Twelve secondary neoplasms occurred in 11 patients, and the cumulative incidence was 1.3% at 5 years, 4.8% at 10 years, and 5.8% at 15 years. The eye preservation rate was 100% in group A, 88% in group B, 65% in group C, 45% in group D, and 30% in group E according to the International Classification of Intraocular Retinoblastoma. Fifty-one percent of eyes had a visual acuity >0.5, and 36% of eyes had a visual acuity >1.0 at the last follow-up examination in cases without macular tumors.

Conclusions: Selective ophthalmic arterial injection using a balloon catheter and melphalan achieved a success rate of 98.8% and was associated with few severe adverse events, including secondary neoplasms. More than half of the treated eyes were preserved, and more than half of the eyes without macular tumors maintained a visual acuity >0.5. Selective ophthalmic arterial injection is an established treatment method. We did not detect severe eye damage or severe systemic events; secondary neoplasms were seen but no more frequently than would otherwise have been expected.

Financial disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.