Chemotherapy can save eyes

A direct ophthalmic artery infusion of melphalan for retinoblastoma can enable eyes designated as enucleated to be salvaged, according to a study published in the July 2008 issue of Ophthalmology.

David H. Abramson, MD of Memorial Sloan-Kettering Cancer Center, New York and New York-Presbyterian Hospital, Weill-Cornell Medical Center, New York, US and colleagues studied the tolerability and tumouricidal effect of intra-arterial injections of melphalan chemotherapy in paediatric patients (n=10) with retinoblastoma, whose eyes were indicated for enucleation.

In the Phase I/II trial, cannulations were successful 27 times in nine cases, with one patient undergoing six successful attempts. In each treated patient, tumour regression, and reduction of vitreous seeds and subretinal seeds was dramatic.

No transfusions of red blood cells or platelets were required; no severe systemic complications and no toxicity to the cornea, anterior segment, pupil or motility were noted. Three subjects developed conjunctival and lid oedema that resolved without medical intervention; one previously-irradiated eye developed retinal ischaemia; one eye developed a “radiation-like” retinopathy following brachytherapy subsequent to chemotherapy. In eight cases, vision stabilized or improved. Of all treated cases, seven avoided enucleation; the remaining two were enucleated, with no viable tumours identified pathologically.

Given the high success rate of avoiding enucleation and the low level of side effects, the researchers concluded that the direct arterial infusion of melphalan chemotherapy is a viable method of salvaging eyes indicated for enucleation.