Clinical characteristics and management outcomes of secondary tumour-associated neovascularization in retinoblastoma patients

Purpose: To describe the clinical characteristics of secondary tumour-associated neovascularization (STN) in retinoblastoma (RB) patients and the outcomes and complications of intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) in the treatment of STN. Methods: A single-centre retrospective study. Intravitreal injections of anti-VEGF were given to RB patients once STN was confirmed by fundus fluorescein angiography and performed monthly until neovascularization was resolved. Demographic characteristics, clinical characteristics, treatment outcomes, and complications after anti-VEGF therapy were recorded. Results: STN was detected in twelve eyes of 11 RB patients with a mean age of onset of 15 months. Eleven eyes received intra-arterial chemotherapy (IAC) (mean: 6 cycles, range: 2-11 cycles) before neovascularization onset. After receiving a mean of 4.6 (range: 1-18) intravitreal anti-VEGF injections, 6 eyes first exhibited reduced neovascularization with no relapse; 5 eyes first achieved resolution of neovascularization, but recurrence was observed at follow-up; and one eye received two anti-VEGF injections, but control of neovascularization was not achieved and further injections were refused. Common complications related to anti-VEGF injection included tractional retinal detachment ( n =6) and hyaloid membranes ( n =5). None of the eyes needed enucleation. All the patients were alive without extraocular extension or metastases (mean follow-up 64 months, range: 37-112 months). Conclusion: STN can occur in RB patients after multiple comprehensive therapies, especially IAC. Intravitreal anti-VEGF injection contributes to the resolution of neovascularization, but anti-VEGF treatment-related complications must be recognized and anticipated.