THE LATEST PUBLISHED RESEARCH

Efficacy of Intravitreal Bevacizumab Therapy for Neovascular AMD
Investigators assessed the efficacy of intravitreal bevacizumab injections for eyes with neovascular age-related macular degeneration (NVAMD) and poor initial visual acuity (VA) in this retrospective study. Included were 44 consecutive treatment-naïve eyes with NVAMD who had initial VA of 0.1 decimal or worse, and that were treated with intravitreal bevacizumab injections. They reviewed charts, optical coherence tomography (OCT) and fluorescein angiograms (FA) for the purposes of this study.

Mean lesion size (SD) was 3375 ± 2116 µm, and according to FA, all lesions showed sub- or intra-retinal fluid in OCT and active neovascularization composed 41.6 ± 17.7% (range 10%-90%) of the lesion area, the investigators noted. Patients received a mean of 2.6 ± 2.42 bevacizumab injections (range: 1-14), and mean VA improved from 1.85 ± 0.64 LogMAR to 1.52 ± 0.77 LogMAR (p=0.002). At final exam, 9 eyes (20%) had reduced VA, 10 eyes (23%) had stable VA and 25 eyes (57%) had improved VA compared with baseline, respectively. Additionally, following treatment, mean macular thickness decreased from 332 ± 98 µm, to 248 ± 79 µm, (p<0.0001).

The study investigators determined that people with NVAMD and poor initial VA should not refrain from using bevacizumab and that selection of patients with signs of active neovascularization based on ophthalmoscopy, OCT and FA may increase the likelihood of favorable response to treatment.

Source: Galbinur T, Averbukh E, Banin E, et al. Intravitreal bevacizumab therapy for neovascular age related macular degeneration associated with poor initial visual acuity. Br J Ophthalmol 2009; June 10 [Epub ahead of print]. DOI: 10.1136/bjo.2009.158931.

Association Between Intravitreal Ranibizumab and Retinal Arteriolar Vasoconstriction in Patients with Neovascular AMD
In this prospective, consecutive, interventional case series, researchers studied the effect of intravitreal (IVT) ranibizumab on the retinal arteriolar diameter in patients with neovascular AMD in 11 eyes of 11 patients with previously untreated neovascular AMD. All eyes had 3 monthly IVT injections of ranibizumab. The researchers measured the diameter of the retinal arterioles in vivo with a retinal vessel analyzer (RVA) before the first IVT injection and then 7 and 30 days after the first, second and third injections.

Primary endpoints for this case series were changes in retinal arteriolar diameter and mean arterial pressure (MAP) after IVT ranibizumab, while secondary endpoints were changes in best-corrected visual acuity (BCVA), central retinal thickness and IOP after IVT ranibizumab, and appearance of adverse events during the follow-up period.

The study researchers observed a significant decrease of the retinal arteriolar diameter after each IVT injection of ranibizumab and 30 days after the first, second and third injections, there was a mean decrease of 8.1 ± 3.2%, 11.5 ± 4.4% and 17.6 ± 7.4%, respectively, of the retinal arteriolar diameter compared with baseline values (p<0.01). Additionally, there was no significant change in MAP during the period of follow up (p>0.05). Mean BCVA improved by 6.5 ± 4.9 Early Treatment Diabetic Retinopathy Study (ETDRS) letters 30 days after the third IVT injection of ranibizumab and central retinal thickness decreased by 91 ± 122 µm, (p=0.03).

Per the researchers, these results suggest that IVT ranibizumab may induce retinal arteriolar vasoconstriction in patients with neovascular AMD after IVT ranibizumab and further studies evaluating larger sample sizes are needed to confirm these results as well as potential adverse effects on the retinal circulation in patients with AMD and retinal vascular diseases.

Source: Papadopoulou DN, Mendrinos E, Mangioris G, et al. Intravitreal Ranibizumab May Induce Retinal Arteriolar Vasoconstriction in Patients with Neovascular Age-related Macular Degeneration. Ophthalmol 2009;June 29 [Epub ahead of print]. DOI: 10.1016/j.ophtha.2009.03.017.

Ranibizumab Treatment and Early Neovascular Bridging of CNV
Investigators in Spain reported three cases of early choroidal neovascularization (CNV) bridging after ranibizumab treatment in which two different foci of CNV showed a great tendency to decrease patients’ vision because of neovascular bridging with foveal implication.

They treated three patients with two separated foci of CNV secondary to age-related macular degeneration (ARMD), pathologic myopia and multifocal choroiditis with monthly injections of ranibizumab for a period of 3 months. The investigators noted that all three cases showed early coalescence across the fovea of the two neovascular foci, already 1 month after the first ranibizumab injection. Best-corrected visual acuity (BCVA) decreased in the three cases more than 20 letters due to early foveal involvement.

Source: Reche-Frutos J, Calvo-Gonzalez C, Donate-Lopez J, Garcia-Feijoo J. Early neovascular bridging of choroidal neovascularization after ranibizumab treatment. Graefes Arch Clin Exp Ophthalmol 2009; July 21 [Epub ahead of print]. DOI: 10.1007/s00417-009-1143-1.

Ranibizumab Monotherapy for Exudative AMD: Injection Frequency and Visual Acuity Outcomes
To evaluate the visual outcomes for intravitreal ranibizumab administered on an as-needed basis for exudative AMD and to investigate the relationship between injection frequency and visual outcome in this setting, 131 eyes with treatment-naïve, exudative AMD undergoing ranibizumab monotherapy were included in this retrospective, interventional case series.

Intravitreal ranibizumab was administered on an as-needed basis guided by clinical examination and optical coherence tomography (OCT) and the OCT scans were evaluated by the treating physicians for the presence of intraretinal fluid, subretinal fluid, intraretinal cysts or increasing pigment epithelial detachment size. In addition, clinical data, including visual acuity (VA), choroidal neovascularization lesion morphology and treatment course were collected retrospectively for analysis and mean change in best-corrected Snellen VA was used as the main outcome measure.

It was reported that the mean age was 81.3 years, mean follow up was 12 ± 4.3 months (minimum 6 months, median 12 months) and mean number of injections was 5.2 ± 2.8. Mean baseline Snellen VA for the entire population was 20/110 and significantly improved at 6 months (20/80; p=0.0002) and at last follow up (20/90; p=0.0066). At 6 months, 31% of eyes had gained at least 3 lines of VA and 90.5% had avoided loss of 3 lines. On average, it took 3.0 injections and 3.5 months to achieve a “dry” or “flat” macula on OCT after initiating treatment. Resolution of intra- and subretinal fluid on OCT did not correlate with the degree of vision improvement. Moreover, eyes receiving more frequent injections (defined as <2 months mean inter-injection interval) gained more vision (+2.3 lines at 6 months) than eyes receiving injections less frequently (+0.46 lines at 6 months; p=0.012). It was also noted that at 6 months, 3.1% of those in the more frequent injection group lost >3 lines of vision compared with 15.9% in the >2 months interval group (p=0.011).

In a population receiving as-needed injections of ranibizumab for exudative AMD, visual improvement was related to the frequency of injections but not to the resolution of fluid by OCT. The findings of this study led to the conclusion that treatment with ranibizumab on a strictly as-needed basis may result in undertreatment and significantly less visual gain.

Source: Dadgostar H, Ventura AA, Chung JY, et al. Evaluation of injection frequency and visual acuity outcomes for ranibizumab monotherapy in exudative age-related macular degeneration. Ophthalmol 2009; In press.

Treatment of CNV Secondary to Angioid Streaks with Intravitreal Bevacizumab Injections
The authors of this observational case series investigated the long-term efficacy of intravitreal injections of bevacizumab for choroidal neovascularization (CNV) secondary to angioid streaks. They found that an intravitreal injection of bevacizumab seems to maintain visual acuity; however, CNV frequently recurred or new CNV developed during the long follow up.

Included in this study were 15 eyes of 13 patients (5 men, 8 women; mean age 59 years; range 54 to 70 years) treated with 1 mg intravitreal bevacizumab injections. Excluded were eyes that had undergone previous treatments. The minimum follow up after the first injection was 12 months. The study authors measured best-corrected visual acuity (BCVA) and examined optical coherence tomography and fluorescein angiography images before and after treatment.

They noted that the mean follow up was 19 months (range, 12 to 24 months), the mean number of injections for primary CNV was 4.5 (range, 1 to 9) and that the mean preoperative BCVA (decimal equivalent) was 0.39 (range, 0.08 to 1.5) and 0.47 (range, 0.06 to 1.2) at the final visit (p=.355). The BCVA improved by 2 lines of logarithm of the minimum angle of resolution visual acuity at the final visit in 5 eyes (33%), was unchanged in 8 eyes (54%) and decreased in 2 eyes (13%). According to the authors, the final fluorescein angiography examination showed no leakage in 10 eyes (67%), minimal leakage in 2 eyes (13%) and persistent or recurrent leakage in 3 eyes (20%). Additionally, five eyes (33%) had a recurrence 4 to 7 months (mean, 5.1 months) after the last bevacizumab injection and new CNV lesions developed in different areas in 3 eyes (20%) 6 to 14 months after the last bevacizumab injection for primary CNV.

Source: Sawa M, Gomi F, Tsujikawa M, et al. Long-term results of intravitreal bevacizumab injection for choroidal neovascularization secondary to angioid streaks. Am J Ophthalmol 2009; June 22 [Epub ahead of print].

Comparing Treatments for Choroidal Neovascularization Attributable to Pathologic Myopia
Japanese researchers conducted this retrospective, comparative, interventional case series to compare the visual outcomes of intravitreal bevacizumab and sub-Tenon triamcinolone acetonide (TA) for choroidal neovascularization attributable to pathologic myopia (mCNV). They included 54 consecutive eyes of 53 patients with mCNV (20 treated with sub-Tenon TA and 34 treated with intravitreal bevacizumab) in an institutional setting. Main outcome measures included best-corrected visual acuity (BCVA) 12 months after the initial injection and logarithm of the minimum angle of resolution gain from baseline compared with analysis of covariance (ANCOVA).

According to the researchers, at 12 months, the BCVA improved by 1.9 lines in the intravitreal bevacizumab group and worsened by 0.3 lines in the sub-Tenon TA group; thus, the intravitreal bevacizumab group had significantly greater visual improvement than the sub-Tenon TA group (p<.01). Also, statistical analysis (ANCOVA) revealed that age (p=.01), pretreatment BCVA (p<.01) and the treatment choice (intravitreal bevacizumab or sub-Tenon TA; p=60;.01) correlated significantly with the BCVA and the BCVA gain at 12 months. The refractive error was of borderline significance (p=.06).

Intravitreal bevacizumab seems to result in a more favorable visual outcome than sub-Tenon TA in the treatment of mCNV, the researchers concluded. However, this study is limited by its retrospective nature. Patient age, the BCVA before treatment and the refractive error must be considered to initiate treatment.

Source: Wakabayashi T, Ikuno Y, Gomi F, et al. Intravitreal bevacizumab vs sub-tenon triamcinolone acetonide for choroidal neovascularization attributable to pathologic myopia. Am J Ophthalmol 2009; July 9 [Epub ahead of print]. DOI: 10.1016/j.ajo.2009.05.026.

Panretinal Photocoagulation's Effect on RNFL Thickness and Optic Nerve Appearance
Investigators enrolled patients with diabetes who did and did not undergo panretinal photocoagulation (PRP) and nondiabetic control subjects in this study to determine whether PRP alters retinal nerve fiber layer (RNFL) thickness and optic nerve appearance. A total of 94 eyes of 48 healthy individuals, 89 eyes of 55 diabetic patients who did not undergo PRP and 37 eyes of 24 subjects with diabetes who underwent PRP were included in this study.

Participants underwent optical coherence tomography of the peripapillary retina and optic nerve and the investigators graded stereoscopic optic nerve photographs in a masked fashion. They observed that eyes that had been treated with PRP had thinner peripapillary RNFL compared with the other groups; this was statistically significantly different in the inferior (p=.004) and nasal (p=.003) regions. Optic nerve cupping did not increase with severity of disease classification, but the proportion of optic nerves graded as suspicious for glaucoma or as having nonglaucomatous optic neuropathy did (p=.008). These grading categories were associated with thinner RNFL measurements.

The study investigators concluded that diabetic eyes that have been treated with PRP have thinner RNFL than nondiabetic eyes. They also determined that optic nerves in eyes treated with PRP are more likely to be graded as abnormal, but their appearance is not necessarily glaucomatous and may be related to thinning of the RNFL.

Source: Lim MC, Tanimoto SA, Furiani BA, et al. Effect of diabetic retinopathy and panretinal photocoagulation on retinal nerve fiber layer and optic nerve appearance. Arch Ophthalmol 2009;127(7):857-862.

Management of HRBO and BRVO with Intravitreal Bevacizumab
To evaluate the safety and efficacy of intravitreal bevacizumab for the treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO) and hemiretinal vein occlusion (HRVO), the authors of this study conducted a retrospective review of consecutive patients treated with 1.25 mg of intravitreal bevacizumab for ME secondary to BRVO/HRVO from May 2005 to August 2006 with follow up through February 2007. They performed re-treatment at monthly or longer intervals at the discretion of the treating physician.

A total of 52 eyes with a BRVO and 13 eyes with an HRVO received intravitreal bevacizumab at baseline. The study authors observed that visual acuity improved by a mean of 12 letters at 1 month (n=51; p<0.001), 13 letters at 3 months (n=61; p<0.001), 13 letters at 6 months (n=42; p<0.001), 14 letters at 9 months (n=27; p<0.001) and 15 letters at 12 months (n=17; p=0.015). They reported that the mean optical coherence tomography (OCT) thickness decreased by 184 µm (p<0.001), 131 µm (p<0.001), 161 µm (p<0.001), 158 µm (p=0.002) and 205 µm (p=0.002) at 1 month, 3 months, 6 months, 9 months and 12 months, respectively. The mean number of injections was 1.4, 2.1, 2.7 and 3.1, and 3.3 at 1 month, 3 months, 6 months, 9 months and 12 months, respectively. No ocular or systemic adverse events were observed.

The authors observed improvements in visual acuity and OCT outcomes during the first year after intravitreal bevacizumab in patients with ME secondary to BRVO and HRVO.

Source: Gregori NZ, Rattan GH, Rosenfeld PJ, et al. Safety and efficacy of intravitreal bevacizumab (Avastin) for the management of branch and hemiretinal vein occlusion. Retina 2009;29(7):913-925.

Low-Dose Recombinant Tissue Plasminogen Activator in Retinal Vein Occlusion
Researchers from Germany conducted this prospective, randomized, controlled multicenter trial to investigate the efficacy of intravenous thrombolysis with low-dose recombinant tissue plasminogen activator (rt-PA) in recent-onset central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO). They enrolled 52 patients with CRVO (n=41) or BRVO (n=11), best-corrected visual acuity ≤20/50 and onset of symptoms within 11 days before treatment. In each group, they randomized patients to either hemodilution or thrombolysis with 50 mg of rt-PA with concomitant intravenous heparinization. The primary clinical outcome measure was improvement in best-corrected visual acuity from baseline at 1 year.

Patients with CRVO who were treated with rt-PA exhibited a significant improvement in best-corrected visual acuity compared with those who received hemodilution (p<0.0001). At 1-year follow up, the proportion of eyes with CRVO achieving an improvement in visual acuity of three or more lines was 45% after treatment with rt-PA and 21% after hemodilution therapy, according to the researchers. They noted that the median final best-corrected visual acuity among CRVO patients given rt-PA was 20/60 (light perception, 20/15) compared with 20/400 (light perception, 20/20) in the hemodilution group. Furthermore, they observed no significant differences among patients with BRVO as well as no serious adverse events. Finally, they found no significant differences regarding the development of ocular neovascularization.

The study researchers reported that treatment with intravenous low-dose rt-PA improved visual outcome in CRVO and that thrombolysis was not associated with a lower risk of ocular neovascularization, indicating that the mechanisms involved in this process occur at an early stage.

Source: Hattenbach LO, Friedrich Arndt C, Lerche R, et al. Retinal vein occlusion and low-dose fibrinolytic therapy (R.O.L.F.): A prospective, randomized, controlled multicenter study of low-dose recombinant tissue plasminogen activator versus hemodilution in retinal vein occlusion. Retina 2009;29(7):932-940.

Effects of Vitrectomy on PO2 in CRVO
In this prospective, controlled, interventional pilot study, the effects of vitrectomy on PO2 in the vitreous cavity in central retinal vein occlusion (CRVO) were investigated. Included were six patients with ischemic CRVO in one eye (undergoing vitrectomy for radial optic neurotomy [RON]) and six with either macula hole or membrane. Mean age was 65 years. (In patients with CRVO, measurements were taken before RON was performed.) Before removal of the vitreous (pre-vitrectomy) and after removal of the vitreous (post-vitrectomy), an oxygen probe was inserted and oxygenation recordings (PO2) were taken in the mid-vitreous cavity and the preretinal vitreous.

In controls, the mean PO2 adjacent to the retina (15.0 mmHg S.D. 5.7) was significantly less than mid-cavity (33.7 mmHg S.D. 12.8) pre-vitrectomy. Similarly in CRVO, the pre-vitrectomy pre-retinal PO2 (8.1 mmHg S.D. 3.5) was significantly less than mid-cavity (19.8 mmHg S.D. 7.3). The mean PO2 was significantly less in the eyes with CRVO than in control eyes. Post-vitrectomy, the PO2 was reportedly significantly greater than pre-vitrectomy at both recording sites in the controls mid-cavity (61.5 mmHg S.D. 13.9) and pre-retinal (75.8 mmHg S.D. 9.1) as well as in CRVO eyes mid-cavity (53.7 mmHg S.D. 17.9) and pre-retinal (59.8 mmHg S.D. 15.8).

It was concluded that PO2 is reduced in the vitreous cavity in CRVO. Vitrectomy may be a method of increasing oxygen availability to the retina.

Source: Williamson TH, Grewal J, Gupta B, et al. Measurement of PO2 during vitrectomy for central retinal vein occlusion, a pilot study. Graefes Arch Clin Exp Ophthalmol 2009;247(8):1019-1023.

Impact of Pretreating Diabetic Eyes with Bevacizumab on Visual Outcome and Recurrent Vitreous Hemorrhage
This consecutive, retrospective and comparative cohort study evaluated the safety and effect of bevacizumab pretreatment on the incidence of recurrent vitreous hemorrhage and visual acuity after vitrectomy for proliferative diabetic retinopathy. It identified and reviewed patients undergoing vitrectomy from September 2006 through November 2007 at the Emory Eye Center for complications of proliferative diabetic retinopathy.

A total of 33 eyes pretreated with bevacizumab and 104 untreated eyes were observed for postoperative vitreous hemorrhage and final visual acuity and patients in the bevacizumab group were significantly younger than those in the untreated group (average age, 46.4 vs. 58.4 years) and were more likely to have 20-gauge instrumentation (58% vs. 36%). On average, 9.6 days passed between injection and surgery and it was reported that early (4-6 weeks) rebleed rates were 15% versus 13% in the bevacizumab and untreated groups, respectively, and not statistically different. Furthermore, preoperative (7/200 vs. count finger at 4'), 1-month postoperative (20/200-3 vs. 20/150) and 3-month postoperative visual acuity (20/100-3 vs. 20/100+2) were not statistically different between groups. No statistical difference was found in rebleed rates regarding the gauge of vitrectomy.

In conclusion, bevacizumab pretreatment for diabetic vitrectomy was not associated with any observed complications, but did not influence rates of postoperative vitreous hemorrhage or final visual acuity in this retrospective series. The overall incidence of postoperative early vitreous hemorrhage in this series was 13% and seems lower than historically reported rates.

Source: Lo WR, Kim SJ, Aaberg TM, et al. Visual outcomes and incidence of recurrent vitreous hemorrhage after vitrectomy in diabetic eyes pretreated with bevacizumab (Avastin). Retina 2009;29(7):926-931. doi: 10.1097/IAE.0b013e3181a8eb88.

Success of Intravitreal Bevacizumab for Refractory Pseudophakic Cystoid Macular Edema
To determine the feasibility, safety and clinical effect of intravitreal (IVT) bevacizumab in patients with refractory cystoid macular edema after cataract surgery, investigators conducted an interventional, retrospective, multicenter study involving 36 eyes of 31 patients with refractory CME after cataract surgery and with a mean age of 68.2 years (range, 67-87 years). They treated patients with at least 1 IVT injection of 1.25 or 2.5 mg bevacizumab and followed them for 12 months. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) by optical coherence tomography (OCT) were the main outcome measures.

The investigators observed that 26 eyes (72.2%) demonstrated improvement of BCVA (≥2 Early Treatment Diabetic Retinopathy Study [ETDRS] lines) and that no eye experienced worsening of visual acuity (≥2 ETDRS lines). In addition, mean baseline BCVA was 20/200 (0.96 logarithm of the minimum angle of resolution [logMAR] units) and the mean 12-month BCVA was 20/80 (0.62 logMAR units; p<0.0001). Optical coherence tomography demonstrated that mean CMT at baseline was 499.9 µm (range, 298-784 µm) and decreased to a mean of 286.1 µm (range, 168-499 µm) at 12 months (p<0.0001). According to investigators, four (11%) eyes received 2 injections, 10 (27.8%) eyes received 3 injections, 10 (27.8%) eyes received 4 injections, 1 (2.8%) eye received 5 injections and 1 (2.8%) eye received 6 injections. They reported that the mean number of injections was 2.7 (range, 1-6), and the mean interval between injections was 15.1 weeks (range, 4-45 weeks). They observed no ocular or systemic adverse events.

Short-term results suggest that IVT bevacizumab is well tolerated in patients with refractory pseudophakic CME. The study investigators also concluded that treated eyes had a significant improvement in BCVA and decrease in macular thickness by OCT at 12 months.

Source: Arevalo JF, Maia M, Garcia-Amaris RA, et al. Intravitreal bevacizumab for refractory pseudophakic cystoid macular edema: The Pan-American Collaborative Retina Study Group Results. Ophthalmol 2009;June 22 [Epub ahead of print]. doi:10.1016/j.ophtha.2009.04.006.

Imaging GA Margins with Spectral Domain Optical Coherence Tomography
Scientists in this study sought to test in vivo whether spectral domain optical coherence tomography (SD-OCT) provides adequate resolution for reproducible measurement of photoreceptor (PR) layer at the margins of geographic atrophy (GA) and whether it delineates the relationship between PR layer and retinal pigment epithelium at the margins of GA.

Participants in this prospective, consecutive case series included patients with GA secondary to nonneovascular AMD identified during routine follow up at Duke Eye Center between January 3, 2006 and June 3, 2007 and who consented to participate in this study.

To image eyes, the scientists used SD-OCT. Multiple B-scans from each eye were saved and independently graded at the site where PR thickness began to decline below its baseline, at the site where PR layer disappeared and at the site of the GA margin by 2 graders. These data were processed to calculate the locations of PR losses relative to GA margins and were categorized as (A) bridging across GA margins, (B) entirely within GA margins or (C) entirely outside GA margins. The scientists calculated location of PR loss (bridging across GA margins, entirely within GA margins or entirely outside GA margins) and measured distances from the GA margin for beginning and ending of PR loss. Interobserver agreement was determined for categories of PR loss as well as locations of PR loss relative to the GA margin.

According to the scientists, they analyzed 500 unique scans and the PR loss occurred most frequently bridging across the GA margin (65% scans), second most frequently entirely inside the GA margin (29% scans) and least frequently entirely outside the GA margin (6% scans). Loss of PR started an average of 61 µm (standard deviation [SD] ± 235) outside the GA margin, ended an average of 311 ± 273 µm inside the GA margin, and spanned an average of 372 ± 179 µm.

Relative to GA margins in nonneovascular AMD with GA, SD-OCT provides adequate resolution for quantifying PR loss. Additionally, it may also serve as a means of tracking disease progression in future interventional trials.

Source: Bearelly S, Chau FY, Koreishi A, et al. Spectral domain optical coherence tomography imaging of geographic atrophy margins. Ophthalmol 2009;July 29 [Epub ahead of print]. DOI:10.1016/j.ophtha.2009.04.015.

Outcome of Treating Group D Heritable Retinoblastoma with Primary Chemotherapy
To report the ocular survival and event-free survival following primary multi-agent chemotherapy for group D, heritable bilateral retinoblastoma (RB), the RB database was used to identify children with heritable, bilateral RB treated with primary chemotherapy (six cycles of vincristine, etoposide and carboplatin). Only Group D eyes with more than 12 months' follow up were analyzed and the timing, number and type of salvage treatments were recorded. Additionally, Kaplan–Meier estimates for the ocular survival and event-free survival (percentage of eyes that avoided external beam radiotherapy and/or enucleation) were performed as a function of time.

Of 18 group D eyes, two (11%) were treated successfully with chemotherapy alone, nine (50%) underwent successful salvage treatment and seven (39%) were enucleated. The median time from completing chemotherapy to enucleation was 9 months (range 4 to 25 months) and ocular survival was 67% at 2 years. Moreover, external beam radiotherapy proved successful salvage treatment in five of nine eyes, so the event-free survival was 34% at 2 years.

It was concluded that multi-agent chemotherapy alone is rarely sufficient for the preservation of group D eyes and that external beam radiotherapy and plaque radiotherapy remain important salvage treatments for advanced, heritable retinoblastoma.

Source: Cohen VM, Kingston J and Hungerford JL. The success of primary chemotherapy for group D heritable retinoblastoma. Br J Ophthalmol 2009;93(7):887-890.