Periocular hemangiomas in childhood – functional and esthetic results

Clinical review of periorbital capillary hemangioma of infancy

PURPOSE

To explore the role of intralesional steroid injections (ILSI) and oral steroids in the management of periocular hemangioma of infancy (HOI).

METHODS

In this retrospective study, treatment options studied were observation, ILSI, and oral steroids. All children received adjunctive amblyopia treatment if required. The main indications for treatment were cosmetic, worsening astigmatism, and visual axis obscuration. Success was defined as complete HOI regression before the age of 5 years (cosmetic group), reduction of astigmatism of at least 1 diopter cylinder (DC) (astigmatism group), or no evidence of amblyopia at the last follow-up (visual axis obscuration group).

RESULTS

Twenty-four of 41 children (58.5%) had amblyopia at presentation. Eighteen children formed the observation group, 17 children received ILSI, and 6 children received oral steroids. Successful outcome was achieved in all except 2 patients in the cosmetic group and 6 of 7 in the visual axis obscuration group. Mean astigmatic correction of all cases was 1.65 ± 1.34 DC before treatment and 0.91 ± 1.17 DC after treatment, the change being statistically significant (P < .001).

CONCLUSION

Observation appears to be a highly effective strategy if coupled with amblyopia therapy, especially for mild cases. Intralesional and oral steroids appear to be equally effective for lesions requiring treatment, but their exact role cannot be clearly determined in the presence of a spontaneously resolving lesion.

Current management of infantile hemangiomas

During the past several years, there have been new advancements in the management of infantile hemangiomas (IHs). In many patients, no treatment is ever necessary--because IHs are well known for their natural history of spontaneous involution. However, a significant minority of hemangiomas do require treatment. Moreover, they are very heterogeneous, making the decision of when, how, and why to intervene quite variable. The least common but most important rationale for intervention is the presence of a life- or function-threatening complication, where prompt therapeutic intervention is a necessity. A much more common scenario is ulceration, where appropriate management is needed to expedite healing and control pain. Increasingly, the life-altering aspects of hemangioma are being recognized as a rationale for treatment because permanent scarring and disfigurement can result even if involution is complete. Treatments for IHs currently include topical, intralesional, and systemic therapies. Laser and surgical modalities are also sometimes used depending on the clinical scenario. In the absence of rigorous evidence-based studies, clinicians must carefully weigh the risks and benefits of medical or surgical treatments versus observation alone in tailoring management to the specific clinical situation at hand.

Combined surgical method of orbital and periorbital hemangioma treatment in infants

PURPOSE

To analyze the results of application of combined surgical treatment in different forms of hemangioma in infants.

MATERIALS AND METHODS

One hundred seventy-four children with different forms of orbital and periorbital hemangiomas aged 1-16 months (mean age 5.2 + 1.97 months) were operated on at the pediatric ophthalmology department. Fast growth of hemangioma, both superficial (intradermal) and deep (subdermal and orbital) localization, significant deformity of eyelids, with narrowing of eye fissure were the indications for surgical treatment. The combined-staged method, including cryosurgery of superficial intradermal lesions and surgical excision of subdermal and/or orbital parts of the tumor in different combinations depending on the form and depth of hemangioma spreading, was applied.

RESULTS

Usage of cryodestruction usually on the first stage of treatment allowed gentle scarring of the angiomatously changed skin areas. Surgical excision of the deep part of the tumor eliminated disfigurement and visual axis occlusion, avoiding amblyopia development. Good cosmetic and anatomic result was achieved in 90.4% of cases.

CONCLUSION

Combined surgical method of treatment of progressive capillary hemangiomas by using cryosurgery and surgical excision in infants allows the choice of optimum tactics depending on features of the course and clinical picture in each individual case and provides achievement of high cosmetic and functional result of treatment. The early beginning of treatment in cases of fast progressing of the tumor allows prevention of extensive skin affection and amblyopia development.

Orbit and eyelid hemangiomas: Is there a relationship between location and ocular problems?

PURPOSE

Infantile hemangiomas of the orbit and eyelid can cause serious ocular problems, such as astigmatism and amblyopia. Magnetic resonance imaging and ultrasonography are the best ways to establish the diagnosis and to evaluate the extent of the lesion. Our goal was to correlate the lesion location with the visual impairment.

MATERIAL AND METHODS

This was a retrospective study (1992-2004) of 63 cases of orbit and eyelid hemangiomas (13 male, 50 female patients; ages: 1 day old to 3 years old). Imaging methods were magnetic resonance imaging or computed tomographic-scanning and color Doppler ultrasonography. The anatomic definition was palpebral, extraconal, and extraconal with intraconal involvement. All patients had ophthalmologic evaluations.

RESULTS

The hemangiomas were palpebral (n = 32) (normal vision: 19; amblyopia and/or astigmatism: 13), extraconal, and extraconal with intraconal involvement (n = 31) (normal vision: 4; amblyopia and/or astigmatism: 27).

LIMITATIONS

This study was small; a prospective study is needed.

CONCLUSION

Orbit and eyelid hemangiomas need to be carefully evaluated by an ophthalmologist. Extraconal and intraconal hemangiomas are more frequently associated with ocular involvement. However, ocular complications can occur in palpebral lesions.

Magnetic resonance imaging of orbital tumors

This contribution provides an overview of diseases of eye and orbit and their appearance on magnetic resonance imaging. In recent years the diagnosis of eye and orbit pathology has profited significantly from increasingly sophisticated technical developments in the field of tomographic methods. Due to the small size of the examination area the improvement in spatial resolution and soft tissue contrast leads to an increase in image quality. In most clinical questions concerning eye and orbit pathologies magnetic resonance imaging is superior to computed tomography and should be early performed.

[Appearance of orbital diseases on MRI]

We provide an overview of diseases of the orbit and their MR imaging appearance. Over recent years MRI has become established in the diagnosis of orbit diseases. There is a selection of different surface coils for examination. The choice of surface coil depends on the clinical question and the anatomical region under consideration. In addition, the significance of the different sequences and the value of contrast medium administration are discussed.

Basic science and clinical aspects of vascular anomalies

PURPOSE OF REVIEW

Patients with vascular and lymphatic anomalies are often 'medical orphans' ascertained through distinct medical specialists. Multidisciplinary vascular anomalies programs provide focused expertise in diagnosis and treatment for patients. National and international workshops on vascular anomalies are fostering clinical and basic science research to enhance our understanding of vascular development and vascular anomalies. Herewith is presented an update of recent advances in the study of vascular/lymphatic anomalies.

RECENT FINDINGS

New original findings include (1) the identification of distinct cell surface markers and other cellular properties in hemangiomas and vascular malformations relevant to vascular development, (2) the discovery of novel genetic mutations and susceptibility genes in patients with vascular anomalies, (3) recognition of new risk stratifications and clinical issues for patients with hemangiomas and vascular malformations, and (4) the elucidation of sequelae from the disorders as well as side effects of recent and previous therapies for vascular anomalies.

SUMMARY

Vascular anomalies are an attractive model for the study of human disorders of vasculogenesis and angiogenesis. The etiology of these disorders is unclear and likely represents a multifactorial process. Clinical clues are leading to scientific investigations that may enable targeted therapies, prevention strategies, or both.