Adjunctive techniques for optimization of ocular hemodynamics in children undergoing ophthalmic artery infusion chemotherapy.

PURPOSE: To develop a reproducible technique for selective ophthalmic artery infusion chemotherapy (SOAIC) that is technically efficacious in children with unfavorable patterns of ophthalmic artery (OA) flow. MATERIALS AND METHODS: Initially, all SOAIC was performed with intention to treat using a standard selective OA (microcatheter) infusion technique (sSOAIC). Temporary balloon occlusion (TBO) of the external carotid artery (ECA), a balloon-assisted SOAIC (bSOAIC) technique, was performed only if OA angiography did not show robust and sustained anterograde OA flow. In our more recent experience, all SOAIC was performed with intention to treat by bSOAIC. Verapamil infusion into the OA and internal carotid artery was performed in selected cases. Technical success was defined as delivery of chemotherapeutic agent(s) into the OA with robust and sustained anterograde perfusion. sSOAIC was considered to have failed if converted to bSOAIC. RESULTS: 19 eyes were treated in 17 patients (age 5 months to 16 years) between December 2008 and May 2013. Eighty-three procedures were undertaken and the OA was successfully catheterized in all. Technical success was achieved in 35/41 (85%) sSOAIC cases and 42/42 (100%) bSOAIC cases. TBO of the ECA augmented anterograde OA flow and converted all cases of retrograde OA flow to anterograde. Verapamil further augmented anterograde ocular perfusion during SOAIC. There were no access site complications, strokes, or deaths. CONCLUSIONS: TBO of the ECA is a safe, effective, and reproducible method for optimizing ocular hemodynamics during SOAIC regardless of baseline OA flow pattern. Verapamil infusion may further favorably modify OA flow. TRIAL REGISTRATION NUMBER: NCT01466855.

Postherpetic neuralgia involving the right C5 dermatome treated with a cervical transforaminal epidural steroid injection: a case report.

A 66-year-old woman presented with 2 weeks of debilitating right upper-limb pain with a vesicular rash over the right C5 dermatome secondary to herpes zoster. Her pain failed to improve with: oral narcotics, divalproex, gabapentin, pregabalin, and topical 2% lidocaine cream. Six weeks postonset, a right C5 transforaminal epidural steroid injection (TESI) under fluoroscopic guidance was performed. Prior to the injection, her numeric pain intensity was rated as 9 to 10/10, and 15 minutes after the injection, it was reduced to 3/10. At 2 weeks, her pain had maintained an intensity of 3/10 and over another 2 weeks had resolved. She remained pain-free 3 months later. In this case, the use of a cervical TESI provided dramatic results in the treatment of debilitating postherpetic neuralgia (PHN). Further investigation is needed to determine the efficacy of TESI in the early management of PHN.