Transient Optical Coherence Tomography Changes after High-Dose Intravitreal Topotecan for retinoblastoma: case series.
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PURPOSE: To report and describe transient spectral-domain OCT (SD-OCT) changes following high-dose intravitreal topotecan (HD-IvitTopo) in retinoblastoma patients. DESIGN: Retrospective case series. SUBJECTS: Three eyes of three children with retinoblastoma treated with HD-IvitTopo (100 μg/0.20 cc), 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 one 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 first combined intravitreal and intracameral topotecan injection. In all cases, all structural changes resolved completely within 10-16 weeks, with no permanent visual loss at date last seen. CONCLUSIONS: High-dose IvitTopo (100 μg/0.20 cc) 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.