Ophthalmic Vascular Events Following Primary Unilateral Intra-arterial Chemotherapy for Retinoblastoma in Early and Recent Eras: A Consecutive Comparative Analysis

Purpose: To better assess the posterior segmen side effects of intra arterial chemotherapy, we performed a retrospective review of ophthalmic vascular events following IAC.Methods: A retrospective comparative analysis. Results: There were 76 eyes of 76 patients treated with primary IAC at this center, divided into early (22 eyes, 57 infusions) and recent (54 eyes, 186 infusions) eras. IAC consisted of melphalan (243 infusions), topotecan (124 infusions), and carboplatin (9 infusions). A comparison (early vs. recent era) revealed fewer mean number of infusions (2.6 vs. 3.4 p=0.02) with similar mean patient age (24 vs. 29 months, p=0.50), International Classification of Retinoblastoma group (p=0.17), largest tumor diameter (19 vs. 18mm, p=0.49), thickness (10 vs. 10mm, p=0.87), vitreous seed extent (p=0.68), and subretinal seed extent (p=0.47). Event rates decreased over time (p<0.01), with fewer overall ophthalmic vascular events (early era vs. recent era) in the recent era (59% vs. 9% per eye, 23% vs. 3% per infusion, p<0.01), including peripheral retinal nonperfusion (5% vs. 2%, p=0.50), vitreous hemorrhage (9% vs. 2%, p=0.20), subretinal hemorrhage (0% vs. 2%, p=0.99), branch retinal vein occlusion (5% vs. 0%, p=0.29), choroidal ischemia (14% vs. 4%, p=0.14), and ophthalmic artery spasm/occlusion (27% vs. 0%, p<0.01). Events did not correlate to patient age (p=0.75), tumor diameter (p=0.32), tumor thickness (p=0.59), or cumulative dosage of melphalan (p=0.13) or topotecan (p=0.59). There were no IAC-induced vascular events in 21 consecutively-treated eyes in 2016-2017. Conclusion: Ophthalmic vascular events following IAC have decreased from the early era (2009-2011) through the current era (2012-2017). Experience performing this highly specialized procedure could be an important factor predicting IAC-related vascular events.