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Research Letter |

Retinal Vascular Precipitates During Administration of Melphalan Into the Ophthalmic Artery

Rosanne Superstein, MD1,2; David Lederer, MD3; Josee Dubois, MD4; Patrick Hamel, MD1,2; Anne-Sophie Carret, MD5,6; Sonia Callejo, MD, PhD1,2,3
[+] Author Affiliations
1Department of Ophthalmology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
2Department of Ophthalmology, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
3Department of Ophthalmology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
4Department of Imaging, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
5Division of Hematology-Oncology, Departments of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
6Division of Hematology-Oncology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
JAMA Ophthalmol. 2013;131(7):963-965. doi:10.1001/jamaophthalmol.2013.1469.
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Extract

We describe the real-time ophthalmic findings during 3 consecutive bilateral superselective intraophthalmic artery chemotherapy treatments in a 5-month-old baby with retinoblastoma.

Article InformationCorresponding Author: Sonia Callejo, MD, PhD, Department of Ophthalmology, Centre Hospitalier Universitaire Sainte-Justine, 3175 Cote-Sainte-Catherine, Montreal, QC H3T 1C5, Canada (guilleyso@hotmail.com)

Author Contributions:Study concept and design: Superstein, Dubois, Hamel, Callejo.

Acquisition of data: Superstein, Hamel, Callejo.

Analysis and interpretation of data: Superstein, Lederer, Dubois, Carret, Callejo.

Drafting of the manuscript: Superstein, Lederer, Carret, Callejo.

Critical revision of the manuscript for important intellectual content: Superstein, Lederer, Dubois, Hamel, Callejo.

Administrative, technical, and material support: Superstein, Lederer, Carret, Callejo.

Study supervision: Superstein, Lederer, Callejo.

Conflict of Interest Disclosures: None reported.

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Figure 1.
Serial Fundus Photographs Taken During the Second Intra-arterial Treatment of the Right Eye

A, Intra-arterial retinal precipitates were noticed 8.5 minutes into the treatment, affecting all 4 quadrants. B, Following abortion of treatment, reperfusion proceeded centrifugally in a pulsatile manner. C, The posterior pole was reperfused within the first 90 seconds. D, Full reperfusion of the posterior pole and peripheral retina was noticed clinically 9.5 minutes later.

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Figure 2.
Fundus Photographs of the Left Eye

Fundus photographs of the left eye prior to the first intra-arterial treatment (A) and during the third treatment (B). Note the presence of retinal pigment epithelial clumping inferonasally from the optic nerve (B), in an area not previously affected by the tumor. Also, note the presence of intraretinal perfusion gaps in the temporal aspect of the macula. These precipitates were noticed 20 minutes into the infusion and persisted for a total of 9 minutes. B, The photograph was taken 4.5 minutes into the ischemic episode. Observe the dramatic response of the juxtapapillary tumor to superselective intraophthalmic artery chemotherapy.

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