Transient OCT Changes after High-Dose Intravitreal Topotecan for Retinoblastoma: Case Series.

PURPOSE: To report and describe transient spectral-domain OCT (SD-OCT) changes after high-dose intravitreal topotecan (HD-IvitTopo) in patients with retinoblastoma.

DESIGN

Retrospective case series.

SUBJECTS: Three eyes of 3 children with retinoblastoma treated with HD-IvitTopo (100 μg/0.20 mL), administered either as monotherapy during first-line treatment for macular (case 1) or optic nerve-threatening tumors (case 2), or combined with intracameral topotecan for vitreous and aqueous humor relapse (case 3).

METHODS

Clinical examination, fundus photography, and SD-OCT were performed before and after each intravitreal injection. Full-field electroretinography (ERG) was assessed in 1 case.

MAIN OUTCOME MEASURES: Structural retinal changes on SD-OCT, reversibility of retinal alterations and functional outcomes.

RESULTS

All cases received 1 to 2 HD-IvitTopo injections. Case 1 developed early signs of loss of the ellipsoid zone and diffuse microcystic macular edema after the first HD-IvitTopo, which worsened after the second, without ERG alterations. Case 2 developed isolated foveolar cystic edema after the second HD-IvitTopo. Case 3 developed transient papillary and diffuse microcystic macular edema after the combined intravitreal and intracameral topotecan injection. In all cases, all structural changes resolved completely within 10 to 16 weeks, with no permanent visual loss at the date last seen.

CONCLUSIONS

High-dose IvitTopo (100 μg/0.20 mL) may induce transient, subclinical intraocular alterations detectable by SD-OCT. Further studies are warranted to elucidate the exact cause, incidence, and functional impact of such events.

FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.