Evaluation of Retinal Toxicity in Pediatric Oncology Patients Receiving Platinum-Based Chemotherapy

Improved survival among pediatric oncology patients has increased the burden of late treatment-related complications, including retinal toxicity, a recognized acute and chronic effect of platinum chemotherapy. This study aimed to characterize retinal toxicity associated with platinum agents and compare the toxicities of cisplatin and carboplatin.

Thirty-six pediatric patients (22 girls, 14 boys) who had completed platinum-based chemotherapy and were in remission were evaluated. Patients with pretreatment ocular disease or impaired renal function were excluded. Oncologic data and ophthalmologic findings including visual acuity, refractive errors, color vision, optical coherence tomography (OCT) (retinal nerve fiber layer thickness [RNFLT]; central foveal retinal thickness [CFRT]), and optical coherence tomography angiography (OCTA) (superficial capillary plexus [SCP]; deep capillary plexus [DCP]) vessel density were obtained retrospectively from medical records. Thirty-six age- and sex-matched healthy children without ocular or systemic disease served as controls.

Seventy eyes from the patient group and 72 from controls were analyzed. Time since last chemotherapy was negatively correlated with left-eye CFRT. Higher cumulative cisplatin dose was associated with reduced CFRT and thinning of RNFLT in the nasal-superior quadrant, while carboplatin dose showed no significant effect.

Obvious retinal toxicity does not occur with platinum chemotherapy within the dosage range the patients received. The decrease in CFRT and RNFLT with a higher dose of cisplatin suggested that cisplatin may cause more retinal toxicity than carboplatin. The negative correlation between CFRT and duration since last chemotherapy suggests that RNFLT might get thinner over time; therefore, these patients need lifelong ophthalmologic follow-up.