PURPOSE To evaluate clinical outcomes and enucleation rates after intravitreal melphalan (IVM) alone and after IVM combined with intravitreal topotecan (IVT) for the treatment of vitreous disease, and to a lesser extent subretinal and retrohyaloid seeds, in patients with retinoblastoma. STUDY DESIGN A retrospective analysis of 77 eyes of 72 consecutive patients. METHODS Demographic data, classification of tumors, seed type (dust, sphere or cloud) before injection and at the end of follow-up, injection type (IVM or IVM+IVT), doses of IVM and IVT, number of injections, follow-up time, enucleation status and side effects were recorded. Cox regression analysis and log-rank test for Kaplan-Meier curves were performed. RESULTS Of 77 eyes, 40 received IVM alone (group 1) and 37 received IVM+IVT (group 2). Enucleation rates were 62.5% (n=25) in group 1 and 10.8% (n=4) in group 2 (p=0.001). Median eye survival was 23.6 months in group 1 and 25.6 months in group 2. Mantel-Cox test revealed statistically significant differences between Kaplan-Meier curves of group 1 and 2 (p=0.022). Multiple Cox regression analysis showed a significantly elevated enucleation rate associated with: IVM only treatment group (p=0.019) and pre-injection cloud type of seeding (p=0.014). CONCLUSION The combined use of intravitreal melphalan and topotecan provides significantly better results in terms of avoiding enucleation and vitreal and subretinal seed control.

中文翻译：

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比较玻璃体腔内美法仑与托泊替康和不加托泊替康治疗视网膜母细胞瘤的玻璃体疾病。

目的评估玻璃体腔内美法仑（IVM）以及IVM与玻璃体拓扑替康（IVT）联合应用后，在视网膜母细胞瘤患者中治疗玻璃体疾病以及较小程度的视网膜下和透明质样种子的临床疗效和去核率。研究设计回顾性分析了72例连续患者的77眼。方法人口统计学资料，肿瘤分类，注射前和随访结束时的种子类型（粉尘，球形或云状），注射类型（IVM或IVM + IVT），IVM和IVT剂量，注射次数，随访记录时间，去核状态和副作用。进行了Cox回归分析和Kaplan-Meier曲线的对数秩检验。结果77只眼中，有40只接受IVM治疗（第1组），有37只接受IVM + IVT治疗（第2组）。去核率是62。组1为5％（n = 25），组2为10.8％（n = 4）（p = 0.001）。第1组的眼中位生存期为23.6个月，第2组的眼中位生存期为25.6个月。Mantel-Cox检验显示，第1组和第2组的Kaplan-Meier曲线之间存在统计学差异（p = 0.022）。多重Cox回归分析显示，与以下因素相关的去核率显着升高：仅IVM处理组（p = 0.019）和注射前云种的播种（p = 0.014）。结论玻璃体内马法兰和托泊替康联合使用在避免去核，玻璃体和视网膜下种子控制方面提供了明显更好的结果。多重Cox回归分析显示，与以下情况相关的去核率显着升高：仅IVM处理组（p = 0.019）和注射前云种的播种（p = 0.014）。结论玻璃体内的美法仑和拓扑替康联合使用在避免去核，玻璃体和视网膜下种子控制方面提供了明显更好的结果。多重Cox回归分析显示，与以下因素相关的去核率显着升高：仅IVM处理组（p = 0.019）和注射前云种的播种（p = 0.014）。结论玻璃体内马法兰和托泊替康联合使用在避免去核，玻璃体和视网膜下种子控制方面提供了明显更好的结果。