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R. Yeilding, S. Donahue, L. A. Mawn; Surgical Management of Capillary Hemangiomas. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5293.
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The purpose of this study is to show that surgical resection of Capillary Hemangioma (CH) is a safe and effective treatment, and should be considered as primary treatment when CH is causing pupillary occlusion visual obstruction or induced astigmatism.
Retrospective chart review of the 10 patients from Vanderbilt Eye Institute who underwent surgical excision of CH from October 31, 1999 to Oct 31, 2009.
Visual obstruction was the primary indication for surgery (5 pts); others indications were amblyopia (3 pts), increasing astigmatism (1 pt), and tissue diagnosis (1 pt). Seven patients had resection at <11 months of age (average 16.9, range 2 mos- 48 mos). Two patients had treatment preoperatively, both receiving oral steroids and steroid injections, and one receiving laser therapy. In 9 patients, surgical resection was a total resection. All surgical specimens were confirmed as CH by histology. In all patients cosmetic improvement was achieved. One patient required postoperative treatment that included topical steroids and further surgery. Two patients had cycloplegic refractions before and after surgery; in both patients astigmatism was reduced postoperatively (2.25 D and 1.50 D). There were no complications from surgery. The average postoperative time of followup was 8 mos. Four patients had amblyopia preoperatively, and one patient continues to be treated with patching postoperatively. Pupillary occlusion was improved in 5/5; 1/5 still who had both anisometropia and occlusion has anisometropic amblyopia and continues to patch.
Previous studies have shown that earlier treatment of CH’s leads to better results [i]. In addition, CH's causing papillary occlusion and induced astigmatism are more resistant to steroid therapy [ii]. This study shows that surgical excision of these CH's is both safe and effective; surgical management avoids the well documented side effects of steroids, leads to few/no recurrences, and achieves desired results such as cosmetic improvement and reduced astigmatism in a timely manner. We are advocating that CH's causing pupillary occlusion or induced astigmatism be treated with primary surgical excision.[i] O'Keefe M, Lanigan B, Byrne S. Capillary hemangioma of the eyelids and orbit: a clinical review of the safety and efficacy of intralesional steroid. Acta Ophthalmol. 2003; 81. 294-298.[ii]Schwartz S, Kodsit S, Blei F, Ceisler E, Stelle M, Furlan L. Treatment of capillary hemangiomas causing refractive and occlusional amblyopia. J AAPOS 2007; 11: 577-583.
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