The classification of vitreous seeds in retinoblastoma and response to intravitreal melphalan Journal Article
| Authors: | Francis, J. H.; Abramson, D. H.; Gaillard, M. C.; Marr, B. P.; Beck-Popovic, M.; Munier, F. L. |
| Article Title: | The classification of vitreous seeds in retinoblastoma and response to intravitreal melphalan |
| Abstract: | Purpose To evaluate the clinical characteristics of the 3 classifications of vitreous seeds in retinoblastoma - dust (class 1), spheres (class 2), and clouds (class 3) - and their responses to intravitreal melphalan. Design Retrospective, bi-institutional cohort study. Participants A total of 87 patient eyes received 475 intravitreal injections of melphalan (median dose, 30 μg) given weekly, a median of 5 times (range, 1-12 times). Methods At presentation, the vitreous seeds were classified into 3 groups: dust, spheres, and clouds. Indirect ophthalmoscopy, fundus photography, ultrasonography, and ultrasonic biomicroscopy were used to evaluate clinical response to weekly intravitreal melphalan injections and time to regression of vitreous seeds. Kaplan-Meier estimates of time to regression and ocular survival, patient survival, and event-free survival (EFS) were calculated and then compared using the Mantel-Cox test of curve. Main Outcome Measures Time to regression of vitreous seeds, patient survival, ocular survival, and EFS. Results The difference in time to regression was significantly different for the 3 seed classes (P < 0.0001): the median time to regression was 0.6, 1.7, and 7.7 months for dust, spheres, and clouds, respectively. Eyes with dust received significantly fewer injections and a lower median and cumulative dose of melphalan, whereas eyes with clouds received significantly more injections and a higher median and cumulative dose of melphalan. Overall, the 2-year Kaplan-Meier estimates for ocular survival, patient survival, and EFS (related to target seeds) were 90.4% (95% confidence interval [CI], 79.7-95.6), 100%, and 98.5% (95% CI, 90-99.7), respectively. Conclusions The regression and response of vitreous seeds to intravitreal melphalan are different for each seed classification. The vitreous seed classification can be predictive of time to regression, number, median dose, and cumulative dose of intravitreal melphalan injections required. © 2015 American Academy of Ophthalmology. |
| Keywords: | adolescent; adult; child; event free survival; treatment response; survival rate; major clinical study; outcome assessment; follow up; cohort analysis; melphalan; retinoblastoma; retrospective study; echography; photography; ophthalmoscopy; vitreous body; human; priority journal; article; biomicroscopy |
| Journal Title: | Ophthalmology |
| Volume: | 122 |
| Issue: | 6 |
| ISSN: | 0161-6420 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2015-06-01 |
| Start Page: | 1173 |
| End Page: | 1179 |
| Language: | English |
| DOI: | 10.1016/j.ophtha.2015.01.017 |
| PROVIDER: | scopus |
| PUBMED: | 25795478 |
| DOI/URL: | |
| Notes: | Export Date: 2 July 2015 -- Source: Scopus |
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