Onset and Resolution of Ocular Motor Cranial Nerve Palsies Following the use of Intra-Arterial Chemotherapy for Retinoblastoma
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Authors
Naeem Z.
AlGilgawi A.
Duncan C.
Robertson F.
Sagoo M.
Reddy, A.
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2025
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Article
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Intra-arterial chemotherapy (IAC) has revolutionised the treatment of retinoblastoma with respect to eye salvage; though it does carry ocular side effects. We present a case series assessing the onset and resolution of cranial nerve palsies (NP) following IAC for refractory retinoblastoma. All eyes were initially planned to receive 3 age-adjusted doses of IAC between 2014 and 2020 (inclusive). The initial approach to catheterisation was the same in all cases. All patients were assessed by an Orthoptist and those with NP were followed up for resolution. 41 eyes were treated with IAC. 7 (17%) suffered cranial nerve palsies (NP) following a median of 3 (2-12) doses of IAC. 1 eye had isolated 6th NP, 3 eyes had isolated 3rd NP and 3 eyes had mixed 3rd and 6th NP. Onset was at a median of 5 days after the injection, and the median age of NP onset was 38 (7-64) months. Full resolution was seen in 5 eyes at a median of 3 months from onset (0.75-26). 1 eye had isolated 3rd NP which did not resolve, and the eye was enucleated. 1 eye had mixed 3rd and 6th NP which improved slightly at 7 months but will require strabismus surgery. NP is an infrequent occurrence after IAC but families need to be aware of this as a complication. It is reassuring that the majority resolve. Persistent NP can be related to high cumulative doses of melphalan, administered in attempt to target refractory tumour control.
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BMJ Open Ophthalmology