085. Intra-Arterial Chemotherapy Administration for Retinoblastoma is Associated with Ophthalmic Artery Flow Variations

Authors: Michael Joseph Feldman, MD

Retinoblastoma (RB) is the most common ophthalmologic malignancy in children. The development of catheter-based intra-arterial chemotherapy (IAC) has revolutionized the RB treatment paradigm. The variable nature of ophthalmic artery flow, either retrograde from anastomoses with external carotid artery (ECA) branches or anterograde from the internal carotid artery (ICA), has led to the development of multiple endovascular techniques for drug delivery. We sought to evaluate the direction of ophthalmic artery flow and identify reversal of ophthalmic artery flow during the course of treatment.Methods: We performed a retrospective analysis of all RB patients who completed treatment with IAC and an aged-matched control population who underwent cerebral angiography at our center.
IAC was performed in 18 eyes (15 patients). Of the 18 eyes treated, 12 (66%) had anterograde ophthalmic artery flow. Flow reversal was observed 5 times (28% of eyes), each instance necessitating alteration in drug delivery technique. All 5 events were in patients receiving multi-agent chemotherapy. No correlation was found between reversal events and endovascular treatment technique. 89 sequential angiograms (41 patients, 82 eyes) were evaluated for control. Retrograde flow was seen in 13 eyes (15%). Of the 19 patients (37 eyes) with sequential angiograms, flow reversal was seen in 2 eyes, both in the same patient treated for an ECA fistula.
Ophthalmic artery flow is variable in RB patients treated with IAC. Shifts between anterograde and retrograde ophthalmic artery filling are common and necessitate variation in delivery methods throughout a single treatment course. All flow reversal events were in patients receiving multi-agent chemotherapy (as opposed to Melphalan alone). Although the correlation was not statistically significant, our analysis is limited by power. Retrograde flow was observed initially in our control cohort, with some instances of flow reversal. This suggests OA flow reversal may be a physiologic phenomenon independent of IAC.