Ophthalmology. Retina最新文献

Objective: Evaluate the outcomes of intra-arterial chemotherapy (IAC) for the treatment of naive and non-naive retinoblastoma eyes. Ocular survival rates, risk factors for enucleation, ocular complications, metastatic disease, and overall survival were analyzed.

Design: A retrospective, single-institution study PARTICIPANTS: A total of 300 patients treated with IAC between April 2010 and April 2023 were included.

Interventions: During IAC infusions, 1-3 drugs were used (melphalan, 3.0-7.5mg; topotecan, 0.3-2.0 mg; carboplatin, 20-50 mg). Adjuvant therapy was used as needed to consolidate treatment.

Main outcome measures: Ocular survival rates, ocular complications, and the risk factors for enucleation were measured.

Results: A total of 357 eyes were treated with 1,536 IAC infusions, with a median of four cycles per eye, and followed for 60.69 months. The Kaplan-Meier estimates for the overall ocular survival were 90% at 1, 89% at 2, and 86% at 5 years. No difference in ocular survival was found between IAC indications (primary 88% vs secondary 85% vs bridge 89%; p = 0.52) or for the use of tandem therapy (tandem 85% vs no tandem 87%; p = 0.93). Intravitreal chemotherapy as adjuvant therapy was used in 31.37% and plaque therapy in 5% of the eyes. The group did not receive external beam radiation. Univariable and multivariable analyses showed that the presence of subretinal seeds was significantly associated with an increased risk of enucleation, and the use of ophthalmic artery (OA) ostium in >50% of infusions per eye was a protective factor to avoid enucleation. Retinal and/or choroidal vascular, ischemic, or atrophic effects were the most frequent complications found in 5.0% of the eyes. Metastatic disease was observed in 0.33% of the patients. The overall 5-year patient survival was 99.3%.

Conclusions: The use of IAC in different indications (primary, secondary, bridge, and tandem) to treat naive or recurrent-refractory retinoblastomas showed successful results. Most eyes were preserved. Subretinal seeds at presentation were associated with a high enucleation risk. The use of the OA ostium for drug delivery avoided enucleation.

This study describes a follow-up and retreatment algorithm after intravitreal bevacizumab injection for retinopathy of prematurity. All eyes had favorable structural outcomes over a 12-year period. Universal prophylactic laser was not needed with careful long-term follow-up.

Purpose: We reviewed outcomes using intravitreal bevacizumab 0.03 mg to treat retinopathy of prematurity (ROP) after switching to this dose in November 2018.

Design: Multi-center, retrospective, non-randomized, non-masked, consecutive case series.

Methods: Results from 62 patients (123 eyes) treated between November 2018 and September 2023 with low-dose intravitreal bevacizumab, 0.03 mg in 0.03 ml, by four treating physicians were reviewed.

Main outcome measures: Primary outcome measures were percentage of eyes having initial regression of ROP and percentage of eyes that received subsequent laser treatment. Secondary outcomes were time between bevacizumab and subsequent laser treatment, number of laser spots, and percentage with recurrence of ROP.

Results: All eyes had initial regression of ROP. Of the 123 eyes, 42 (34%) received laser treatment at some point after bevacizumab; 34 (28%) for persistent avascular retina (PAR) and 8 (7%) for reactivation of ROP. The average time between bevacizumab and laser was 16 ± 6 weeks for PAR and 13 ± 5.8 weeks for recurrent ROP. The mean number of laser spots per eye was 496 ± 247 for PAR and 905 ± 915 for recurrent ROP (p = 0.028). No eyes developed stage 4 or stage 5 ROP.

Conclusion: Based on historical comparisons, a 0.03-mg dose of intravitreal bevacizumab was as effective as a 0.625-mg dose for treatment of ROP. These data provide additional evidence from clinical practice to support the use of a 0.03-mg dose of bevacizumab for treatment of ROP.