Complications of Selective Intraarterial Chemotherapy in Children with Intraocular Retinoblastoma

Abstract

Introduction: Selective ophthalmic arterial injection (SOAI) therapy for intraocular retinoblastoma is currently recognized by the world ophthalmic-oncological communities and this method is used in leading specialized institutions. However, the using of this type of treatment can lead to complications. Side effects can be both systemic, affecting the course of the procedure itself, and local in nature, associated with intraocular changes.Purpose: Conduct an analysis of complications during SOAI in children with intraocular retinoblastoma.Material and methods: The study includes the results of treatment of 110 children (129 eyes) with unilateral and bilateral retinoblastoma who received SOAI both with insufficient efficacy of previous treatment for resistant and recurrent forms of RB (99 children / 116 eyes), and as primary local chemotherapy without previous treatment (11 patients / 13 eyes). 313 procedures were performed, of which the treatment stage was completed in 303 cases. Depending on the hemodynamic characteristics of the blood supply to the eye and the orbital region, 2 methods of delivering of the chemotherapy were used: 1) microcatheter technique (245 procedures performed; 81.0 %) 2) microballoon technique (58 procedures performed; 19.0 %).Results: The structure of the complications was as follows. 1. The group of intraoperative complications included: spasm of the ICA, cerebral arteries — 4 cases (1.3 %), acute cardio-respiratory manifestations and hemodynamic instability — 93 (29.7 %). 2. Group of general complications: cerebrovascular accident — 3 cases (0.9 %), hematological toxicity — 14 (4.5 %). 3. Group of local complications. A) External extraocular manifestations: transient eyelid edema — 49 (15.7 %), frontal arteritis — 2 (0.6 %), ptosis of the upper eyelid — 11 (3.5 %), ptosis and deviation of the eyeball — 2 ( 0.6 %), soft tissue necrosis — 1 (0.3 %). B) Intraocular manifestations: retinal detachment — 13 (4.2 %), chorioretinal atrophy — 4 (1.2 %), edema of the optic nerve head — 2 (0.6 %), atrophy of the optic nerve head — 1 (0.3 %), hemophthalmia — 3 (0.9 %).Conclusion: Modern interventional endovascular methods allow to carry out the SOAI safety and reduce the number of possible complications.