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   Table of Contents      
LETTER TO THE EDITOR
Year : 2017  |  Volume : 65  |  Issue : 9  |  Page : 901-902

Comment: Intra-arterial chemotherapy for retinoblastoma


Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication14-Sep-2017

Correspondence Address:
Usha Singh
Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_476_17

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How to cite this article:
Kaur S, Singh U, Gupta V, Bansal D. Comment: Intra-arterial chemotherapy for retinoblastoma. Indian J Ophthalmol 2017;65:901-2

How to cite this URL:
Kaur S, Singh U, Gupta V, Bansal D. Comment: Intra-arterial chemotherapy for retinoblastoma. Indian J Ophthalmol [serial online] 2017 [cited 2020 Feb 24];65:901-2. Available from: http://www.ijo.in/text.asp?2017/65/9/901/214649

We congratulate the authors on an expounded study on intra-arterial chemotherapy (IAC) for retinoblastoma (RB) published in your esteemed journal.[1] Although the authors write an illustrative series, we believe that there are certain questions unanswered on the topic.

In the handful of studies on IAC for RB, the rate of successful catheterization reported is 98%.[2] Did the authors ever find the ophthalmic artery inappropriate for selective catheterization? What were the alternative routes taken if the ophthalmic artery was not fully developed, or if the access from the internal carotid artery was too acute?

Did the authors document the visual acuity or encounter any case of foveal/choroidal atrophy? Long-term visual outcomes after intravenous chemotherapy (IVC) are well known, but despite the efficacy of the IAC; we are yet unaware of its visual outcomes. Could the potentially high dose of focused chemotherapy be causing more ischemic complications leading to an overall poor visual outcome despite a globe salvage?

The protocols followed for advanced RB are imprecise, largely influenced by personal choice and technical resources. Since the patients received 1–11 cycles of IVC, the indications of IAC are not reflected from the study. Only two cases treated by authors were unilateral, but we should remember that unilateral nongermline advanced diseases are best treated by IAC.[2] Furthermore, the authors were unable to compare the outcomes of primary and secondary IAC due to smaller numbers.

Successfully running a separate RB clinic for the past 20 years,[3] we share our experience in IAC for RB in [Table 1]. Although literature does not address this issue, three patients developed new lesions after IAC in our series.
Table 1: Details of patients receiving intra-arterial chemotherapy

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We endorse IAC in selective cases of RB but until well-established indications are laid down; we should use this modality with caution.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Rishi P, Sharma T, Sharma M, Maitray A, Dhami A, Aggarwal V, et al. Intra-arterial chemotherapy for retinoblastoma: Two-year results from tertiary eye-care center in India. Indian J Ophthalmol 2017;65:311-5.  Back to cited text no. 1
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2.
Zanaty M, Barros G, Chalouhi N, Starke RM, Manasseh P, Tjoumakaris SI, et al. Update on intra-arterial chemotherapy for retinoblastoma. ScientificWorldJournal 2014;2014:869604.  Back to cited text no. 2
[PUBMED]    
3.
Singh U, Katoch D, Kaur S, Dogra M, Bansal D, Kapoor R. Retinoblastoma: A sixteen-year review of the presentation, treatment, and outcome from a tertiary care institute in Northern India. Ocul Oncol Pathol 2018;4:23-32. [DOI 10.1159/000477408].  Back to cited text no. 3
    



 
 
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