This information describes what to expect during and after your child’s ophthalmic (op-thal-mik) artery chemosurgery (OAC).
Dr. Abramson and our retinoblastoma team at Memorial Sloan Kettering (MSK) have recommended ophthalmic artery chemosurgery (OAC) to treat your child’s retinoblastoma (cancer of the eye). OAC is a procedure used to treat tumors in the eye. For this procedure, chemotherapy is injected directly into your child’s ophthalmic artery (a blood vessel in the eye). This is done in an outpatient setting, which means that your child won’t have to be admitted to the hospital.
This procedure will be performed by Dr. Pierre Gobin. He is an interventional radiologist (doctor who specializes in image-guided procedures) at New York-Presbyterian Weill Cornell Hospital.
Your child will need to stop eating and drinking before their procedure. Dr. Gobin’s staff will give you more information on how your child should prepare.
This procedure will be done at New York-Presbyterian Weill Cornell Hospital.
About Your Child’s Procedure
Your child will be given general anesthesia (medication to make them sleep). Once they’re asleep, they may have an intravenous (IV) line inserted. A tiny catheter (a small, flexible tube about half of the diameter of angel hair pasta) will be inserted into 1 of you child’s femoral arteries (blood vessels in your upper leg). It will be threaded through the arteries in their body to their ophthalmic artery (see Figure 1).
Tiny drops (about ⅕ of a teaspoon) of chemotherapy will be placed into the catheter and will go into the eye that needs to be treated. Depending on the extent of your child’s retinoblastoma, they may receive 1 to 3 of the following medications:
- Melphalan (Alkeran®, Evomela®)
- Topotecan (Hycamtin®)
After the chemotherapy is given, the catheter will be removed and a pressure dressing will be placed on the insertion site on your child’s upper leg. The nurse will place a knee brace on your child to keep their leg straight to avoid bleeding.
This procedure takes about 60 minutes.Back to top
After Your Child’s Procedure
- When your child wakes up, they will be in the Post Anesthesia Care Unit (PACU). This is the recovery room. They will spend 5 hours in the PACU.
- While your child is in the PACU, their nurse will check their upper leg and pulse.
- The nurse will let you know when your child can begin drinking and eating.
- The knee brace will be removed once your child is ready to be discharged.
- Make sure your child’s dressing stays on for 24 hours. Do not get the dressing wet.
- Dr. Gobin may prescribe your child a steroid to take by mouth called prednisone (Deltasone®, Rayos®). It will help reduce the swelling and irritation in the treated eye. Have your child take this medication with food to prevent stomach discomfort, as directed by your doctor or nurse.
- Your child may be prescribed ondansetron (Zofran®, Zuplenz®) for nausea or vomiting. Have your child take this medication as directed by their doctor or nurse.
- Your child may also be prescribed tobramycin and dexamethasone (TobraDex®) eye ointment. This medication is a combination of antibiotic and steroid used to reduce swelling and prevent infection in the treated eye. Give this medication to your child as directed by their doctor or nurse.
Your child may experience some side effects after their procedure. These include:
- Redness, swelling, or bruising in their upper leg
- Swelling in the treated eye. This may make it difficult for your child to open their eye.
- Mild discomfort in the treated eye
These side effects will improve 2 to 3 days after your child’s procedure. Some swelling may last for up to 2 weeks.
Your child may also experience some side effects starting 1 to 2 weeks after their procedure. These include:
- Loss of eyelashes in the treated eye.
- Decrease in white blood cell count, also called neutropenia. This can increase your child’s risk for infection.
- For more information, ask the nurse for the resource Neutropenia (Low White Blood Cell Count), or search for it on www.mskcc.org/pe
- Redness above the eyebrow and forehead of the treated eye that may last several weeks.
Your child will need to have their blood drawn 10 days after their procedure. You or your healthcare provider will need to fax these results to Dr. Gobin at 212-746-6653 and Dr. Abramson at 646-227-7275.Back to top
Call Your Child’s Healthcare Provider if They Have:
- Redness or swelling in the treated eye lasting more than 2 weeks
- Increased redness, swelling, or pain in their upper leg
- Nausea or vomiting lasting longer than 2 to 3 days
- Difficulty keeping down prescribed medications due to vomiting
- A temperature of 100.4° F (38° C) or higher
- Pain in the treated eye lasting more than a few days
If you have any questions or concerns about prescriptions or your child’s procedure, call Dr. Gobin’s office. You can reach him Monday through Friday from 9:00 am to 5:00 pm at 212-746-4998. After 5:00 pm, during the weekend and on holidays, call Dr. Gobin’s office and ask to speak with the doctor on call.
For all other questions, call the MSK Retinoblastoma Clinic. You can reach them Monday through Friday from 9:00 am to 5:00 pm at 212-639-7232. After 5:00 pm, during the weekend and on holidays, call 212-639-2000 and ask to speak with the ophthalmologist (eye doctor) or pediatric fellow on call.Back to top