Chemotherapy (usually carboplatin or topotecan) can be injected into the tissues or space surrounding the eye.
When Periocular Injections Are Used
Periocular chemotherapy injections may be used in combination with other therapies to treat medium and large tumours that are not at risk to escape from the eye.
How Periocular Injections Are Given
Injections are given during an EUA.
Periocular means “beside the eye”. The needle does not penetrate the eye itself and chemotherapy is absorbed into the eye through the sclera and cornea. Injections may be subtenon or subconjunctival.
Subtenon: injection of chemotherapy agents into the space behind the eye.
Subconjunctival: injection under the mucus membrane that coats the eye and lines the eyelids.
The chemotherapy drugs used are usually carboplatin or topotecan.
Multiple injections are usually needed to kill the cancer. Local chemotherapy is not used alone, and for very large tumours is not very effective.
Anti-cancer drugs can reach the inside of the eye, without the side effects associated with systemic chemotherapy.
If the eye must later be removed, the surgery may be more difficult if carboplatin has caused tissue fibrosis. Topotecan does not alter the surrounding tissues.
With the drug carboplatin, tissues in and around the eye can become very tough (fibrosis), and fat cells may die (necrosis). This may restrict eye movement and cause a sunken appearance. Topotecan does not alter the surrounding tissues.
Questions To Ask the Doctors
Is this treatment part of a clinical trial?
Can I have a copy of the clinical trial protocol?
How many times have you done this procedure?
Where are my child’s tumours located that you plan to treat?
How big are these tumours?
What kind of periocular injection will you use?
What chemotherapy drugs will you use?
What are the side effects of this injection and the drugs?
Will my child need more than one injection?
How often will you treat the eye?
Will my child receive other treatments in combination with this injection?
How will you combine the treatments?
How might this treatment impact my child’s vision?
What follow-up care will my child receive?
Will my child be followed by a paediatric oncologist?