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January 2001

A Potentially Life-Threatening Adverse Reaction to Verteporfin

Arch Ophthalmol. 2001;119(1):145. doi:

In reply

Dr Gigantelli raises an important question about the necessity of obtaining a long optic nerve specimen during enucleation for the treatment of retinoblastoma. Long-held dictums should be repeatedly subjected to challenge, and we applaud Dr Gigantelli for questioning the wisdom of this traditional teaching.

In support of his argument against the need to obtain a long optic nerve specimen, he provides 3 references that demonstrate no obvious relationship among length of optic nerve resected and/or extension to the cut margin of the nerve, risk of metastasis, and survival. He alludes to the limitations of his own argument when he suggests that the need for a maximal optic nerve resection "should be guided by prospective outcome studies evaluating modern treatment alternatives." The studies that he cites each include only a few patients with optic nerve invasion, making a definitive statement on this topic difficult. Until the prospective data that Dr Gigantelli suggests is available, we will remain in favor of attempting to remove all tumor possible by obtaining a maximum length of optic nerve. Additionally, we do not agree with his views on adjunctive therapies. Despite being highly effective in the treatment of retinoblastoma, chemotherapy and external beam radiation are not without significant complications. Therefore, any reasonable treatment that could potentially minimize the need for application of these modalities is highly desirable.

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