JOURNAL CLUB

RECENT NOTEWORTHY STUDIES TO STIMULATE DISCUSSION AND DEBATE

■ Three-drug chemo for retinoblastoma. A team of ocular oncologists at the Memorial Sloan-Kettering Cancer Center in New York conducted a study of three-drug intraarterial chemotherapy (carboplatin, topotecan, and melphalan) for retinoblastoma. They reported their findings in the October 2012 issue of the British Journal of Ophthalmology.

Twenty-six eyes of 25 patients with varying stages of retinoblastoma were administered three-drug chemo in this retrospective chart review. Seventeen of these cases were recurrences of earlier disease.

After a mean of two infusions per eye and a mean follow-up of 14 months, all of the patients survived, and none developed metastatic disease. Further, only three of the eyes were enucleated due to recurrent disease.

The authors were cautious about the conclusions of the small retrospective study but asserted the usefulness of three-drug chemotherapy in this patient population.

■ PDT for CSC. Photodynamic therapy with Visudyne has been largely eclipsed by anti-VEGF therapy for many retinal diseases, but it continues to play a role in combination therapies. The October 2012 issue of Retina featured the results of a study applying half-fluence PDT in acute central serous chorioretinopathy.

The authors, collaborating among several centers in Austria, undertook a retrospective review of 19 consecutive patients treated with Visudyne/PDT at half fluence (25 J/cm²), guided by indocyanine green angiography. All of the patients had diagnoses of CSC based on SD-OCT and/or fluorescein angiographic findings of subfoveal fluid for at least 12 weeks.

At 12 months, mean BCVA improved from 47 ETDRS letters to 56. In addition, central foveal thickness decreased from 406 μm to 163 μm. All 19 patients experienced complete resolution of their subfoveal fluid. None reported recurrence or adverse events.

The authors conclude that indocyanine green angiography-guided PDT is a safe and effective treatment for acute CSC, particularly given the 30% to 50% relapse rate in the disease’s natural history. They suggest randomized, prospective trials be undertaken.

Figure. An eye with retinal vacuities, in this case caused by cat scratch disease.

REPRINTED FROM JACOBS DJ, SCOTT ML, SLUSHER MM. LOCALISED RETINAL VASCULITIS IN CAT SCRATCH DISEASE. BMJ CASE REPORTS. 2009;2009. PII: BCR09.2008.0904. WITH PERMISSION OF THE BMJ GROUP.

■ Retinal vasculitis study. Retinal vasculitis (Figure) is poorly understood, despite definitions offered by various sources. To eliminate some of this confusion, doctors at the Oregon Health & Science University studied the characteristics and visual outcomes of patients with the disease, and reported their findings in the October 2012 issue of Archives of Ophthalmology.

In a retrospective case series, 321 eyes from 207 cases of retinal vasculitis were analyzed for their characteristics and outcomes. The patients in the series were predominantly non-Hispanic whites with bilateral disease (roughly three-quarters for both characteristics).

The annual mean visual acuity change for eyes with some amount of follow-up was 0.01 logMAR.

Furthermore, more than one-third of the eyes had visual acuity of 20/25 or better at baseline, and one-third of the remaining eyes improved in VA at up to nine years of follow-up. Almost 40% of eyes experienced loss of vision to account for the heterogeneity in diagnoses giving rise to symptoms.

The authors suggested further research into different subtypes of retinal vasculitis.

■ PDT/Avastin for PCV. Polypoidal choroidal vasculopathy remains a serious complication of advanced AMD in Asian populations, so retinal physicians in Taiwan undertook a study of PDT and Avastin in this condition, publishing their findings in the November 2012 issue of the American Journal of Ophthalmology.

Sixty-nine eyes of 69 patients received either PDT with Avastin or PDT alone. Visual acuity increased more than twice as much in the combination therapy arm than in the monotherapy arm at three months, but at six months, the difference was no longer statistically significant.

Instead of treatment modality, predictors of visual improvement were initial BCVA, lesion size, age, and polyp location. The authors suggested combination therapy may have a role in early treatment of maculainvolved PCV.RP