Ophthalmic Artery Chemosurgery: The Remarkable Procedure Saving Children from Eye Cancer

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One of the big challenges in treating retinal glaucoma is to try to retain an eye with vision and cure the cancer. Removing the eye is always an option but again red no blood somus[sp?] in both eyes. I've done it many times but I can't think of a worse that you want to do than removing both eyes of a child.

In 1903, it was first recognized that you could cure this cancer with radiation alone. And in fact, it remains one of the very few solid cancer meaning non-leukemia or lymphoma that can be cured with radiation alone. Thousands of children were treated and thousands of lives were saved and eyes saved.

But, as the children got older, it was recognized that some of those children went on and developed a different kind of cancer, usually a bone cancer which kill them. As a result of that, beginning of the 1990s, physicians switched from using radiation to using chemotherapy intravenous chemotherapy, these are young children.

Chemotherapy works in the sense that tumor shrink that the chemotherapy never cures it. Chemotherapy had many side effects including causing cancer, including causing hearing problem. There were no treatments invented that really to me, had satisfactory profile in safety intoxic[sp?].

So, to cut made the only way you could ever cure Retinal [xx] with systemic chemotherapy would be if you gave such a high doze that is killed the patient, and if it killed the patient of course it will kill the cancer, but any doze less than that you would have the cancer cells surviving and the normal cells not surviving.

So, I thought how could we go about getting a doze of chemotherapy so high that we kill the cancer but to the patients so low that they didn't have this horrible side effects. So, in 1986, Dr. Piero Ben and I got together for the first time, and I proposed to him a way to do this.

And the way to do this is to fill a little caviler, a tool taller than me, but thinner than angle hair pasta. We put it in the blood vessel in the groin of young babies, and then pass it through the blood vessels of the belly, through the blood vessels of the chest, into the blood vessels of the neck, and put it directly into the one blood vessel that goes to the human eye.

There's only one blood vessel that goes to the eye, that's both good and bad. That blood vessel is the size of angel hair pasta is 900 microns, and our caviler is 450 microns, so our caviler is half the thickens of angel hair pasta. When you do that you need to early inject a few drops of chemotherapy.

The dose that you get to the eye, is 100-1000 to a thousand times the drops you get intravenously. But, the drops that leaks into the blood stream, is less than 1% of what the children normally get with intravenous chemotherapy. In May of 2006, we did our first patient, that patient was scheduled to have her eye removed.

They agree to this protocol, the eye was blind, we did it. We waited three weeks and had the child come back, and when the child came back, the cancer was about 95% gone. That began us on the treatment for children, we then recognised if we can do one eye, we can do both eyes simply by, going up one side of the neck, and treating the eye, coming down, going across up the other side of the neck to the other blood vessel coming down.

It's an out patient procedure, it takes an hour. The child go home with a bandage because the dose of chemotherapy is so low, only about one percent of these children ever require blood transfusions. So, the children don't require blood transfusion, they don't get sick, they don't loose their hair, they don't have any of the complications of chemotherapy and it worked..