0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Observation |

Tethered Vitreous Seeds Following Intravitreal Melphalan for Retinoblastoma

Jasmine H. Francis, MD1; Brian P. Marr, MD1,2; Scott E. Brodie, MD, PhD1,3; Yves Pierre Gobin, MD4,5; David H. Abramson, MD1,2
[+] Author Affiliations
1Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
2Department of Ophthalmology, Weill Cornell Medical College, New York, New York
3Department of Ophthalmology, Mount Sinai School of Medicine, New York, New York
4Service of Interventional Neuroradiology, Department of Neurosurgery, Weill Cornell Medical College of New York Presbyterian Hospital, New York, New York
5Service of Interventional Neuroradiology, Department of Neurology and Radiology, Weill Cornell Medical College of New York Presbyterian Hospital, New York, New York
JAMA Ophthalmol. 2014;132(8):1024-1025. doi:10.1001/jamaophthalmol.2014.436.
Text Size: A A A
Published online

Extract

Placing a needle into an eye with retinoblastoma, whether for diagnostic or therapeutic purposes, has historically been avoided owing to concerns of extraocular spread along the needle track.1,2 In the past 3 years, intravitreal injections of melphalan have been used worldwide, with excellent results for vitreous seeding and an exceedingly low risk of extraocular extension.3,4 The treatment course involves repetitive puncture sites with approximately 6 to 8 weekly injections and often a concomitant paracentesis by some groups.3,5 Techniques have been adopted to enhance safety, including reduction of intraocular pressure and cryotherapy of the injection site.5 Despite low documented risk of extraocular extension,4 we describe 2 instances in which active vitreous seeds were drawn toward the ocular surface. While disease did not exit the eye, it did tether to the injection site and eventually regressed with a continuation of treatment.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Figure.
Fundus Photograph of Case 1

A, Vitreous seed tethered to the injection site following 2 intravitreal melphalan injections B, One year later, following cryotherapy and 3 additional injections, the vitreous seed has regressed to a collection of pigment.

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Video.

RetCam Imaging of Case 1

RetCam imaging demonstrates tethering of the seed at the injection site.

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Related Multimedia
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();