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Real-World Comparison Between Primary and Secondary Treatments

Ancona-Lezama, David MD*; Dalvin, Lauren A. MD*,†; Lucio-Alvarez, J. Antonio MD*; Jabbour, Pascal MD; Shields, Carol L. MD*

doi: 10.1097/IAE.0000000000002315
Original Study

Purpose: To determine whether treatment order affects ophthalmic vascular event rates after intra‐arterial chemotherapy (IAC) for retinoblastoma.

Methods: Patients who received IAC as primary or secondary treatment for retinoblastoma from January 2009 to January 2018 were included. All eyes were imaged with fundus photography and fluorescein angiography. Patient characteristics and vascular event rates were compared using t-test and Fisher's exact test.

Results: There were 196 patients treated with 682 infusions of IAC, divided into primary (no previous therapy, 98 eyes of 98 patients, 328 infusions) and secondary (after other therapy, 105 eyes of 98 patients, 354 infusions) treatment. Overall, ophthalmic vascular events were found after 5% of infusions (17% eyes). A comparison of ophthalmic vascular events (primary vs. secondary IAC), with mean three infusions per eye (median 3, range 1–7), revealed no difference in overall percentage of eyes affected (18% vs. 15%, P = 0.57). Adverse vascular events per eye included retinal vasculature attenuation (1% vs. 0%, P = 0.99), peripheral retinal pruning (1% vs. 0%, P = 0.99), branch retinal artery occlusion (0% vs. 1%, P = 0.99), central retinal artery occlusion (0% vs. 1%, P = 0.99), macular ischemia (0% vs. 2%, P = 0.51), vitreous hemorrhage (2% vs. 3%, P = 0.92), subretinal hemorrhage (1% vs. 0%, P = 0.99), retinal pigment epithelium atrophy (6% vs. 3% P = 0.43), choroidal atrophy (4% vs. 2%, P = 0.92), optic disk pallor (1% vs. 0%, P = 0.99), and ophthalmic artery occlusion (9% vs. 6%, P = 0.35).

Conclusion: Ophthalmic vascular events after IAC for retinoblastoma affect only 5% of eyes per infusion (17% of treated eyes). Vascular event risk per eye is similar when using IAC as primary or secondary treatment.

Ophthalmic vascular events after intraarterial chemotherapy for retinoblastoma affect only 5% of eyes per infusion (17% of treated eyes) with similar risk when comparing primary versus secondary therapy. As intraarterial chemotherapy becomes more widely adopted, attention should focus on maintaining tumor control while minimizing vascular side effects.

*Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania;

Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota; and

Department of Endovascular Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania.

Reprint requests: Carol L. Shields, MD, Ocular Oncology Service, 840 Walnut Street, Suite 1440, Philadelphia, PA 19107; e-mail:

Supported in part by the Eye Tumor Research Foundation, Philadelphia, PA (C.L.S.), an unrestricted grant from Research to Prevent Blindness, Inc (L.A.D.), the Heed Ophthalmic Foundation (L.A.D.), and a grant from the VitreoRetinal Surgery Foundation (L.A.D.).

The authors have no conflicts of interest and no financial interest to disclose.

The funders had no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, and in the preparation, review, or approval of the manuscript. C. L. Shields has had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

© 2019 by Ophthalmic Communications Society, Inc.