Retinoblastoma treated with ophthalmic artery chemotherapy infusion

Case contributed by Hazem M Almasarei
Diagnosis almost certain


Visual problems.

Patient Data

Age: 2 years
Gender: Male

There is an irregular heterogeneously contrast-enhancing mass in the right eye globe, mainly occupies in the inferior aspect of the right globe and associated marked retinal detachment and subretinal exudate in the superior portion of the right eye globe. It results in a mass effect on the lens anterior with a small right anterior chamber. There is associated smooth contrast enhancement in the right iris which is mostly due to tumor-induced angiogenesis. The choroid and the sclera appear intact with no evidence of invasion or extraocular extension. The optic nerve appears normal in caliber with no evidence of post laminar optic nerve invasion. The left eye globe and left optic nerve show no masses. The intraorbital fat is clear. The lacrimal glands and the extraocular muscles appear unremarkable.

Selected ophthalmic artery with chemotherapy injection.

Case Discussion

The ostium of the ophthalmic artery has a sharp-angled take off from the C6 segment of the internal carotid artery (usually anteriorly). However, in some cases, it has an anterolateral take-off. After the ostium, the ophthalmic artery has a sharp upward-downward bend in a lateral direction to wrap around the anterior division. The catheters used are usually flowing direction catheters. However, detachable tip microcatheter can be used safely. The average inner diameter of the catheter is 1.0-1.5 Fr. It is important to engage the ostium and simulate the injection rate to verify the total flow of the drug into the ophthalmic artery with no reflux to the internal carotid artery.

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