One method of delivering system chemotherapy for a malignant central nervous system (CNS) tumor involves blood-brain barrier disruption (BBBD). The goal is increase penetration of the chemotherapeutic agents into the CNS. This type of regimen may be associated with a maculopathy.
BBBD involves an intra-arterial infusion of hypertonic mannitol followed by systemic chemotherapy.
The macular changes may involve one or both of the following:
(1) retinal pigmentary changes
(2) reginal pigment epithelium (RPE) geographic atrophy (parafoveal and subfoveal)
(3) parafoveal bull's eye
The risk for the maculopathy increases with the number of treatment sessions.
Complications may develop after the BBBD therapy is completed:
(1) enlargement of geographic atrophy
(2) choroidal revascularization
A patient being considered for a BBBD regimen should:
(1) have a ophthalmologic exam prior to the first session
(2) annual ophthalmologic exams to look for evidence of a maculopathy
