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Brief Report |

Anterior Segment Seeding in Eyes With Retinoblastoma Failing to Respond to Intraophthalmic Artery Chemotherapy

Efthymia Pavlidou, MD1,2,3; Christopher Burris, MD1; Caroline Thaung, FRCPath2,3; Irene Scheimberg, FRCPath4; Judith Kingston, FRCP1,5; John L. Hungerford, FRCS, FRCOphth2; M. Ashwin Reddy, FRCOphth1,2; Mandeep S. Sagoo, FRCS(Ed), FRCOphth1,2,3
[+] Author Affiliations
1Retinoblastoma Service, Royal London Hospital, London, England
2Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, London, England
3University College London Institute of Ophthalmology, London, England
4Pathology Department, Royal London Hospital, London, England
5Paediatric Oncology Department, Great Ormond Street Hospital, London, England
JAMA Ophthalmol. 2015;133(12):1455-1458. doi:10.1001/jamaophthalmol.2015.2861.
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Importance  Anterior chamber seeding following intraophthalmic artery chemotherapy is rarely reported.

Objectives  To describe clinicopathologic observations in eyes in which intraophthalmic artery chemotherapy for retinoblastoma failed and to report anterior chamber involvement.

Observations  A retrospective case series of 12 enucleated eyes (11 patients) with retinoblastoma refractory to intraophthalmic artery chemotherapy between March 1, 2010, and October 31, 2013, at University College London Institute of Ophthalmology and the Retinoblastoma Service, Royal London Hospital. Data analysis was conducted from June 1, 2014, to March 1, 2015. The International Classification of Retinoblastoma groups were B in 1 eye (8%), C in 4 eyes (33%), and D in 7 eyes (58%). Systemic chemotherapy with vincristine sulfate, etoposide, and carboplatin had failed in 10 patients (91%) and 6 eyes (50%) received additional local treatments. In 6 eyes (50%) anterior chamber invasion was clinically detectable. On histopathologic examination, 4 eyes (33%) had no viable retinal tumor; the remainder had poorly differentiated tumor (6 eyes [50%]) or moderately differentiated tumor (2 eyes [17%]). Anterior segment involvement occurred in the ciliary body and/or ciliary muscle (7 eyes [58%]), iris (6 eyes [50%]), and cornea (4 eyes [33%]).

Conclusions and Relevance  Intraophthalmic artery chemotherapy can fail in eyes with retinoblastoma. In contrast to previous reports on outcomes following intraophthalmic artery chemotherapy, our series shows involvement of the anterior segment of the eye, including the ciliary body, iris, and cornea. Careful case selection and follow-up are advised.

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Figure 1.
Anterior Segment Seeding Following Intraophthalmic Artery Chemotherapy, With Involvement of the Ciliary Muscle and Ciliary Body

Tumor seeds in the vitreous cavity (A) and seeds floating in the anterior chamber (B). Histologic findings of tumor cells invading the ciliary body (hematoxylin-eosin, low magnification) (C) and the ciliary muscle (arrowhead) of the same eye (hematoxylin-eosin, higher magnification) (D).

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Figure 2.
Anterior Segment Seeding Following Intraophthalmic Artery Chemotherapy, With Involvement of the Iris and Cornea.

Tumor seeds in the vitreous cavity as well as in the anterior chamber (A) and overlying the iris (B). Histologic findings of tumor seeds invading the iris surface and posterior cornea at low magnification (C) and higher magnification (arrowheads) (D) (hematoxylin-eosin for both).

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