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Choroidal occlusive vasculopathy after intraarterial chemotherapy: MRI findings
Vasculopatía coroidea oclusiva tras quimioterapia intraarterial: hallazgos en la RMN
M. Roca-Cabaua,
, J. Peralta Calvob, F. García Martínezc, A. López-Vázquezd, O. D’Annab
Corresponding author
a Servicio de Oftalmología, Hospital Universitario de Móstoles, Madrid, Spain
b Servicio de Oftalmología Infantil, Hospital Universitario La Paz, Madrid, Spain
c Servicio de Radiología, Hospital Universitario La Paz, Madrid, Spain
d Servicio de Oftalmología, Hospital Universitario La Paz, Madrid, Spain
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Corticosteroids are the first-line therapeutic option for the treatment of OII. Depending on the severity of the inflammation, its course and location, clinicians should establish the route of administration, dose and dosage of treatment.</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">FA: fluorescein angiography; FAG: angiography with indocyanine green; PRP: panretinal photocoagulation; DXM: dexamethasone; IOI: intraocular inflammation; IV: intravenous; IVP: intravenous; mPRDL: methylprednisolone; OCT: optical coherence tomography; OCT-A: angio-OCT; RVO: retinal vascular occlusion; PRD: prednisone; PRDL: prednisolone; TACA: triamcinolone acetonide; RV: retinal vasculitis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Fonollosa, R. Gallego-Pinazo, L. Sararols, A. Adán, M. López-Gálvez, M.S. Figueroa" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Fonollosa" ] 1 => array:2 [ "nombre" => "R." 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"apellidos" => "López-Vázquez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "O." "apellidos" => "D’Anna" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario de Móstoles, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Oftalmología Infantil, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Radiología, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vasculopatía coroidea oclusiva tras quimioterapia intraarterial: hallazgos en la RMN" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 614 "Ancho" => 1305 "Tamanyo" => 95662 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">MRI, axial T1 slice with choroidal thinning in LE and fundus showing complete sectorial atrophy.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The treatment of retinoblastoma has changed enormously in the last decades.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> Intra-arterial chemotherapy (IAC) has been accepted as an effective therapeutic option, both as first and second line in the treatment of retinoblastoma.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> IAC consists of catheterisation of the ophthalmic artery for selective release of chemotherapy drugs.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In cases with bilateral retinoblastoma, “tandem therapy” is performed, which consists of treating both eyes (BE) in the same session, but with different doses so as not to increase the toxicity of the chemotherapy drugs in the tissues: higher grade eyeS with doses of melphalan between 3 and 4<span class="elsevierStyleHsp" style=""></span>mg, and contralateral eyes with 0.5<span class="elsevierStyleHsp" style=""></span>mg. The same doses of carboplatin and topotecan are used for both eyes.</p><p id="par0010" class="elsevierStylePara elsevierViewall">However, this technique also presents complications.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Intraocular side effects after IAC were first described in 2011,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> with choroidal occlusive vasculopathy (COV) being the most frequent.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–11</span></a> COV is an irreversible complication that can be observed as a diffuse or sectorial pigmentary alteration resulting in partial or total atrophy of the choriocapillaris and retinal pigment epithelium.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11–14</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The classification of COV proposed by Munier is based on clinical observations.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The first two stages are incomplete or complete sectoral choroidopathy, respectively. The third stage is diffuse choroidopathy with complete choroidal atrophy affecting 50% of the fundus. Stage 4 includes mixed diffuse choroidopathy: fundus with 50% complete and 50% incomplete atrophy. Finally, stage 5 comprises patients with diffuse choroidopathy with complete atrophy affecting more than 50% of the retina. Each stage is subdivided into three groups: a) without foveal involvement; b) with foveal involvement; c) non-assessable foveal involvement (due to media opacity or foveal location of the tumour).</p><p id="par0020" class="elsevierStylePara elsevierViewall">The consequences on ocular vascularisation have been described clinically and by fluorescein angiography.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Choroidal thinning observed on optical coherence tomography (OCT) has also been described in patients treated with AIC.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Regarding ocular volume, there is one study showing volume reduction in eyes with retinoblastoma at diagnosis compared to the contralateral<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>; although a reduction in axial length has also been observed after IAC.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The results of IAC are promising in terms of tumour control and globe preservation, although ocular toxicity and vascular effects require further analysis. In this article we analyse the adverse vascular effects observed by fundoscopy, and the changes on MRI (Siemens Magnetom Skyre, 3 Teslas) derived from the use of IAC in our sample of 37 eyes. Through this case series, we describe the results observed in the sample, as well as the analysis of similarities and differences between patients who manifest COV and those who do not.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">A retrospective study of 37 eyes of 34 patients with retinoblastoma who were treated with IAC from 2016 to 2021. In patients with retinoblastoma, an initial orbital and brain MRI (Siemens Magnetom Skyre, 3 Teslas, in T1 sequence with contrast) was performed per protocol to exclude pineal tumour or extraocular disease. Serial MRI scans were only performed every six months in genetically positive patients up to five years of age, or in patients diagnosed at less than one year of age without genetic results.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The tumours were classified according to the international classification of retinoblastoma (ICRB): four patients were grade B, one patient grade <span class="elsevierStyleSmallCaps">C</span>, 17 grade D and 15 grade E. Twenty-two patients received systemic chemotherapy with carboplatin, vincristine and etoposide. The remainder received IAC as first-line treatment. In addition, local treatments such as cryotherapy and photocoagulation were performed when necessary. The presence of vitreous seeding was treated with intravitreal melphalan or topotecan.</p><p id="par0040" class="elsevierStylePara elsevierViewall">IAC was performed under general anaesthesia and drugs were administered via femoral artery catheterisation after heparinisation to prevent embolic complications. After cannulation, a 4-French catheter was introduced into the right or left common femoral artery and guided to the internal carotid artery. An angiogram was performed to visualise the vascular tree and to ensure that the microcatheter was positioned at the ostium of the ophthalmic artery prior to drug infusion.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Three drugs were administered: melphalan (3−4<span class="elsevierStyleHsp" style=""></span>mg), carboplatin (40<span class="elsevierStyleHsp" style=""></span>mg) and topotecan (20<span class="elsevierStyleHsp" style=""></span>mg). After complete drug administration, angiography was repeated to verify vessel integrity.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The treatment was repeated every four weeks.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Patients were examined under general anaesthesia on a monthly basis to observe tumour regression and possible complications. In patients with COV, the study was completed with MRI to analyse choroidal thickness and globe length. To measure the anteroposterior length of the eyeball, an axial T2 sequence, three-dimensional volumetric acquisition SPACE sequence was used. For choroidal thickness, an axial T1 sequence with post-contrast fat saturation was used, measuring the thickness in a macular location where the optic nerve was observed.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">COV was observed in five of the 37 eyes that received IAC (13.51%), showing grade 2 involvement and, therefore, complete sectoral choroidopathy with foveal involvement. In some patients, differences in choroidal thickness and anteroposterior asymmetry were found in axial slices on MRI images (axial slices, T1 sequence with contrast).</p><p id="par0065" class="elsevierStylePara elsevierViewall">The first patient received systemic chemotherapy and two cycles of IAC in the left eye (LE) (ICRB grade B). After treatment he presented with type 1 regression of the main tumour and COV. In the axial MRI slices, a clear asymmetry in the ocular anteroposterior diameter was observed, with 20.4<span class="elsevierStyleHsp" style=""></span>mm in the left eye and 21.2<span class="elsevierStyleHsp" style=""></span>mm in the right eye (RE). In addition, choroidal thinning was observed (0.79<span class="elsevierStyleHsp" style=""></span>mm LE and 1.1<span class="elsevierStyleHsp" style=""></span>mm RE) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The second patient had a grade D tumour (ICRB) in the RE. After two cycles of IAC, the fundus examination showed the appearance of COV. No differences were observed in the MRI regarding the anteroposterior diameter of the eyeball between the two eyes (RE: 22.4 / LE 22.2<span class="elsevierStyleHsp" style=""></span>mm). Choroidal thickness measurement was not possible due to a small retinal detachment at the posterior pole (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The third patient had a grade E tumour in both eyes (BE), treated with systemic chemotherapy and tandem IAC. The drug doses were melphalan 0.5<span class="elsevierStyleHsp" style=""></span>mg, topotecan 2<span class="elsevierStyleHsp" style=""></span>mg and carboplatin 40<span class="elsevierStyleHsp" style=""></span>mg in RE. While in LE, melphalan 4<span class="elsevierStyleHsp" style=""></span>mg, topotecan 2<span class="elsevierStyleHsp" style=""></span>mg and carboplatin 40<span class="elsevierStyleHsp" style=""></span>mg were used. Tumour control was achieved in BE; however, it should be noted that only COV was present in LE. In addition, choroidal thinning was observed in LE (1.3<span class="elsevierStyleHsp" style=""></span>mm in RE and 0.75<span class="elsevierStyleHsp" style=""></span>mm in LE) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The fourth child also received tandem therapy after systemic chemotherapy (bilateral retinoblastoma, stage E, in both eyes). He required cryotherapy for control of a subretinal seeding. Drug doses were as follows: RE melphalan 3<span class="elsevierStyleHsp" style=""></span>mg, topotecan 1<span class="elsevierStyleHsp" style=""></span>mg and carboplatin 30<span class="elsevierStyleHsp" style=""></span>mg. In LE melphalan 0.5<span class="elsevierStyleHsp" style=""></span>mg, topotecan 1<span class="elsevierStyleHsp" style=""></span>mg and carboplatin 30<span class="elsevierStyleHsp" style=""></span>mg.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Said patient developed COV in the RE where a small asymmetry in the anterior posterior ocular diameter was observed with respect to the LA (RE 18.3<span class="elsevierStyleHsp" style=""></span>mm/LO: 18.7<span class="elsevierStyleHsp" style=""></span>mm); despite this, no differences in choroidal thickness were observed. Tumour remission was achieved in both eyes (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The last patient was treated with three cycles of IAC in the RE. He had COV and a clear asymmetry of the anteroposterior length of the globe: RE 19.1<span class="elsevierStyleHsp" style=""></span>mm compared to LE (21.8<span class="elsevierStyleHsp" style=""></span>mm). Choroidal thinning was also observed: RE 1<span class="elsevierStyleHsp" style=""></span>mm and LE 1.5<span class="elsevierStyleHsp" style=""></span>mm (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">In this case series, choroidal occlusive vasculopathy was observed in five of the 37 eyes (13.51%) treated with IAC, similar to those seen in other publications.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,11,18</span></a> The cause does not initially appear to be related to melphalan dose, as three patients received 3<span class="elsevierStyleHsp" style=""></span>mg and two patients 4<span class="elsevierStyleHsp" style=""></span>mg. However, if we analyse patients who were treated bilaterally with tandem therapy, we find COV in the eyes with high doses of melphalan (3<span class="elsevierStyleHsp" style=""></span>mg and 4<span class="elsevierStyleHsp" style=""></span>mg). The contralateral eye, treated with doses of 0.5<span class="elsevierStyleHsp" style=""></span>mg, did not present choroidopathy. These patients treated with tandem therapy had bilateral grade E involvement in both eyes. We do not have more patients with these characteristics, but this finding may mean that doses of melphalan higher than 3<span class="elsevierStyleHsp" style=""></span>mg may be associated with the development of COV. The doses of carboplatin and topotecan were the same in both eyes, it does not appear that these drugs are related to the occurrence of COV.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The alteration in choroidal vascularisation remains unclear, it could result from direct damage to the vessels during catheterisation or it could be the result of melphalan toxicity on the vascular tree or on the retinal pigment epithelium. In this case series, the ophthalmic artery could be accessed via the internal carotid artery (ICA) in four of the five patients. The remaining case required access via the external carotid route due to vasospasm in the ICA.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Some patients required three cycles and others two cycles of IAC. In both groups the incidence of COV was approximately the same, so we do not believe that the number of catheterisations (2 or 3) is related to the occurrence of COV.</p><p id="par0110" class="elsevierStylePara elsevierViewall">In four of the five patients the choroidal thickness was decreased, correlating the choroidopathy observed on fundoscopy with choroidal thinning on MRI. In addition, in three cases ocular size was decreased in patients with COV compared to the contralateral eye. It can therefore be suspected that choroidal hypoperfusion may decrease the development of the ocular globe.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Initially, when pigmentary changes are seen, it is difficult to determine whether they are due to incipient choroidopathy or resolution of serous detachments. Perhaps MRI can be another diagnostic test to determine the presence of COV and monitor choroidal and ocular changes.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The main differential diagnosis is pigmentary changes observed after resorption of serous retinal detachments and melphalan chorioretinopathy. In melphalan chorioretinopathy, the visible signs appear on the second day after injection as an area with small intraretinal haemorrhages that progress to retinal atrophy with pigmentary changes around the first month, and are associated with progressive chorioretinal atrophy.</p><p id="par0125" class="elsevierStylePara elsevierViewall">All these patients had good tumour control without the need for additional cycles of IAC or other treatments. It appears that choroidopathy is a marker of treatment intensity, perhaps because choriocapillary involvement also affects the vascularisation of the tumour itself.</p><p id="par0130" class="elsevierStylePara elsevierViewall">With regard to the COV grade, our patients had a grade 2 with foveal involvement. This involvement is an important marker for determining the visual prognosis of these patients. In these cases, due to their age the patients did not cooperate in determining visual acuity and did not tolerate contralateral eye occlusion, which may indicate low vision.</p><p id="par0135" class="elsevierStylePara elsevierViewall">This classification makes it difficult to differentiate between the grades and does not correlate with visual acuity impairment.</p><p id="par0140" class="elsevierStylePara elsevierViewall">These observations provide important information as they emphasise the need to inform parents about the possible complications of IAC that can lead to vision loss in eyes with a good visual prognosis. However, the reason why this complication manifests only in some eyes is still unknown.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0145" class="elsevierStylePara elsevierViewall">Choroidal occlusive vasculopathy developed in five of 37 retinoblastoma eyes treated with IAC, correlating in most patients with choroidal thinning and decreased ocular size on MRI. Melphalan doses in patients receiving tandem therapy may be related to the occurrence of COV.</p><p id="par0150" class="elsevierStylePara elsevierViewall">A new classification may be needed to better correlate visual prognosis and severity of this complication. In addition, MRI may offer another option for the diagnosis and follow-up of COV. Practitioners and parents need to be aware of the benefits and possible side effects before opting for this treatment. In contrast, in patients with high-grade retinoblastoma, where enucleation or external radiotherapy is contemplated, IAC complications are less of a concern.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Although initial results support the use of IAC as a first-line treatment, studies with longer follow-up and thorough documentation of side effects are needed to understand the potential role of IAC in the treatment of retinoblastoma.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0160" class="elsevierStylePara elsevierViewall">This research has not received specific support from public sector agencies, the commercial sector or non-profit organisations.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">No conflicts of interest were declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1838669" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1602324" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1838670" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1602323" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-02-22" "fechaAceptado" => "2022-04-25" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1602324" "palabras" => array:4 [ 0 => "Retinoblastoma" 1 => "Intraarterial chemotherapy" 2 => "Melphalan" 3 => "Occlusive choroidal vasculopathy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1602323" "palabras" => array:4 [ 0 => "Retinoblastoma" 1 => "Quimioterapia intraarterial" 2 => "Melfalán" 3 => "Vasculopatía coroidea oclusiva" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Purpose</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To evaluate magnetic resonance imaging (MRI) findings in patients suffering choroidal occlusive vasculopathy (COV) after intra-arterial chemotherapy (IAC) for retinoblastoma.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A retrospective study of 37 eyes of 34 patients receiving IAQ between 2016 to 2021 as primary or secondary treatment for retinoblastoma was conducted. Twenty-two patients received systemic chemotherapy with carboplatin, vincristine and etoposide. The rest received IAC as primary treatment. The drugs administered were melphalan (3−4<span class="elsevierStyleHsp" style=""></span>mg), carboplatin (40<span class="elsevierStyleHsp" style=""></span>mg) plus topotecan (20<span class="elsevierStyleHsp" style=""></span>mg). The patients were examined under general anaesthesia every month to observe tumor regression and possible complications of the treatment. For the patients with COV an MRI was obtained to analyse the choroidal thickness and axial ocular length.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A COV was observed in 5 of the 37 eyes receiving IAC (13,51%), all of them with a complete sectorial choroidopathy not sparing the fovea (grade 2). In 4 of the 5 patients the choroidal thickness was decreased and in three cases the size of the eye which presented COV was clearly smaller than the contralateral eye. Tumor control was archived in all 5 patients.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">In our cases COV was associated with reduction of thinning of choroid and eye length in the MRI. A new classification maybe needed to correlate better with the severity of the complication affecting the fovea. Although early results generally are favorable to the use of IAC, longer follow up and scrupulous documentation of side effects will be necessary to know the true role of IAC for retinoblastoma.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Evaluar los hallazgos en las imágenes de resonancia magnética nuclear (RMN) en pacientes con vasculopatía coroidea oclusiva (VCO) tras quimioterapia intraarterial (QIA) por retinoblastoma.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Se realizó un estudio retrospectivo de 37 ojos de 34 pacientes que recibieron QIA entre 2016 y 2021 como tratamiento de primera o segunda línea del retinoblastoma intraocular. De estos pacientes, 22 recibieron quimioterapia sistémica y el resto QIA como primera línea, con melfalán (3−4<span class="elsevierStyleHsp" style=""></span>mg), carboplatino (40<span class="elsevierStyleHsp" style=""></span>mg) y topotecan (20<span class="elsevierStyleHsp" style=""></span>mg). Los pacientes fueron examinados cada mes para observar la regresión tumoral y posibles complicaciones de los tratamientos. A los pacientes que presentaron VCO se les realizaron estudios con RMN para evaluar el grosor coroideo y la longitud del globo ocular.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Se observó VCO en cinco de los 37 ojos (13,51%), todos ellos con una coroidopatía sectorial completa con afectación foveal (grado 2). En cuatro de los cinco pacientes el grosor coroideo se vio disminuido, mientras que en tres casos el tamaño del globo afectado era claramente inferior. El control tumoral fue posible en todos los casos.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">En esta muestra, la VCO se asocia con adelgazamiento coroideo y diminución del tamaño ocular en la RMN. Puede ser necesaria una nueva clasificación para correlacionar mejor la severidad de la coroidopatía que afecta a la fóvea. Los resultados iniciales son favorables respecto al uso de la QIA; aunque es necesaria la realización de estudios a largo plazo y una documentación exhaustiva para valorar tanto el papel de la QIA, como los efectos derivados de ella.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Roca-Cabau M, Peralta Calvo J, García Martínez F, López-Vázquez A, D’Anna O. Vasculopatía coroidea oclusiva tras quimioterapia intraarterial: hallazgos en la RMN. Arch Soc Esp Oftalmol. 2022;97:620–625.</p>" ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 598 "Ancho" => 1255 "Tamanyo" => 109399 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Fundus photograph showing complete sectoral choroidopathy with foveal involvement (left image). On the right: axial slice of an MRI, showing asymmetry in the thickness of the choroid (T1 sequence with post-contrast fat saturation) and ocular size (T2 sequence).</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 741 "Ancho" => 1305 "Tamanyo" => 102844 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Top: Fundus photograph of a stage 2 choroidopathy with foveal involvement. Bottom: MRI, axial slice in T2 sequence of the same patient, where no clear asymmetry in ocular size is observed.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 614 "Ancho" => 1305 "Tamanyo" => 95662 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">MRI, axial T1 slice with choroidal thinning in LE and fundus showing complete sectorial atrophy.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 606 "Ancho" => 1305 "Tamanyo" => 78329 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0040" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Axial MRI T-slice showing asymmetry in ocular size with RE being smaller. There are no differences in choroidal thickness (left image). Fundus photograph (right image) with diffuse pigmentary alteration with sectorial choroidopathy and calcification of the tumour.</p>" ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 661 "Ancho" => 1305 "Tamanyo" => 107785 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0045" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Axial MRI shows asymmetry in ocular size (RE 19.1<span class="elsevierStyleHsp" style=""></span>mm and LE 21.8<span class="elsevierStyleHsp" style=""></span>mm) in T2 and choroidal thinning of the RE (RE 1<span class="elsevierStyleHsp" style=""></span>mm/LE of 1.5<span class="elsevierStyleHsp" style=""></span>mm) in T1. Left: the fundus of the same patient with diffuse pigmentary alteration and complete sectorial choroidopathy can be seen.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Combined chemoreduction and adjuvant treatment for intraocular retinoblastoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.L. Shields" 1 => "J.A. Shields" 2 => "M. Needle" 3 => "P. De Potter" 4 => "S. Kheterpal" 5 => "A. 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