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Comment & Response |

Blue Toe Syndrome A Complication of Intra-arterial Technique, Not Intra-arterial Chemotherapy for Retinoblastoma

Darren B. Orbach, MD, PhD1; Deborah K. VanderVeen, MD2; Ankoor S. Shah, MD, PhD2; Carlos Rodriguez-Galindo, MD3
[+] Author Affiliations
1Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
2Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
3Division of Hematology-Oncology, Dana-Farber/Children’s Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
JAMA Ophthalmol. 2014;132(5):654. doi:10.1001/jamaophthalmol.2013.6342.
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To the Editor We read with interest the letter by Sarici et al titled “Blue Toe Syndrome as a Complication of Intra-arterial Chemotherapy for Retinoblastoma.”1 There is a critical distinction to be made between morbidity related to the administration of intra-arterial chemotherapy (IAC) itself—potential direct retinal chemical toxic effects leading to vision loss, for example—and morbidity related to technical mishaps that occur during or after cerebral angiography in infants. The IAC-related morbidity needs to be weighed carefully in considering the risks and benefits of this technique against other treatment modalities such as intravenous chemotherapy, radiation, or enucleation. However, angiographic mishaps are another thing altogether.

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May 1, 2014
Ahmet Sarici, MD; Osman Kizilkilic, MD; Tiraje Celkan, MD
1Department of Ophthalmology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
2Department of Radiology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
3Department of Pediatrics, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
JAMA Ophthalmol. 2014;132(5):654-655. doi:10.1001/jamaophthalmol.2013.8252.
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