中华眼底病杂志

中华眼底病杂志

玻璃体腔注射拓扑替康治疗视网膜母细胞瘤顽固性玻璃体种植短期疗效观察

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目的 观察玻璃体腔注射拓扑替康治疗视网膜母细胞瘤(RB)顽固性玻璃体种植的短期疗效。 方法临床确诊为RB顽固性玻璃体种植患儿11例11只眼纳入研究。其中,男性6例6只眼,女性5例5只眼。年龄9~44个月,平均年龄26个月。依据国际眼内RB分期标准对患眼瘤体进行分期。11只眼中最初分期为E期3只眼,D期6只眼,B期1只眼,A期1只眼。所有患儿曾经全身化疗、经眼动脉灌注化疗、玻璃体腔注射美法仑及激光光凝、冷冻等局部治疗后仍然存在玻璃体种植。所有患儿均行玻璃体腔注射拓扑替康治疗,治疗期间每4周予以全身麻醉检查并治疗1次;根据玻璃体种植是否钙化、纤维化、完全消失决定是否继续治疗。11只眼共注射32次,平均注射2.9次。每只眼注射次数2~4次,中位数3次。平均随访时间10个月。观察玻璃体腔注射拓扑替康治疗RB的安全性及有效性。 结果所有患眼RB玻璃体种植均得以控制。11只眼中,玻璃体种植完全消失9只眼,纤维化2只眼。治疗当天及随访期间所有患儿均未发生眼部或全身并发症、眼眶或全身转移以及需进行眼球摘除手术。 结论玻璃体腔注射拓扑替康治疗RB顽固性玻璃体种植短期疗效较好,且未发现眼部及全身不良反应。

Objective To observe and evaluate the short-term therapeutic effect of intravitreal injection with topotecan for refractory vitreous seeding from retinoblastoma (RB). Methods Eleven patients (11 eyes) of RB with refractory vitreous seeding (received intravenous chemotherapy, intra-arterial chemotherapy, intravitreal melphalan, laser, cryotherapy and subsequently developed refractory viable vitreous seeds) were enrolled in this study. There were 6 males (6 eyes) and 5 females (5 eyes). The aged from 9 to 44 months, with the mean age of 26 months. According to International Intraocular Retinoblastoma Classification, 11 eyes were initially classified as group E (3 eyes), D (6 eyes), B (1 eye) or A (1 eye). All patients were received intravitreal injection with topotecan. A total of 32 intravitreal topotecan injections were performed with a mean of 2.9 injections (median 3 injections; range 2−4 injections). The mean follow-up was 10 months. The safety and effectiveness of intravitreal injection with topotecan for refractory vitreous seeding from RB were observed. Results Complete regression of vitreous seeds was achieved in 11 of 11 eyes (100%), including complete disappearance in 9 eyes and fibrosis in 2 eyes. None of the patients needed enucleation and occured ocular or systemic complications in the follow-up period. Conclusion Intravitreal injection with topotecan for refractory vitreous seeds from RB is effective and safe.

关键词: 视网膜母细胞瘤; 玻璃体种植; 托泊替坎/治疗应用

Key words: Retinoblastoma; Vitreous seeding; Topotecan/therapeutic use

引用本文: 夏杰军, 范若思, 姜华, 刘珍银, 谭小云, 郭轶群, 张靖. 玻璃体腔注射拓扑替康治疗视网膜母细胞瘤顽固性玻璃体种植短期疗效观察. 中华眼底病杂志, 2018, 34(5): 458-461. doi: 10.3760/cma.j.issn.1005-1015.2018.05.009 复制

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