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B. Amspaugh, D. Plager, T. Gillig, D. Moore, D. Risner; Capillary Hemangiomas of the Eyelid and Orbit: A Review of Treatment and Outcomes. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5693.
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Capillary hemangiomas are common benign orbital tumors of infancy. Indications for intervention include amblyopia (occlusion, anisometropia, or strabismus), optic nerve compression, severe proptosis or disfigurement. Recommended treatment for most capillary hemangiomas is observation since many of these lesions regress spontaneously. Steroid injection, systemic steroids and excision are the most common treatments when intervention is indicated. To date, no definite preferred practice pattern exists. This study was designed to evaluate the clinical characteristics and long term results of treatment of these lesions.
A retrospective study was conducted on patients diagnosed with capillary hemangioma who presented to the Pediatric Section of the Department of Ophthalmology, Indiana University, Indianapolis, IN from July 1987 to June 2006. The patient’s medical history, date of birth, age of presentation, visual acuity, strabismus, ptosis, refraction, lesion location, lesion size, imaging, slit lamp and fundus exam, treatment and follow-up were identified.
146 patients were identified. The location of the hemangiomas was as follows: 99 lid, 9 orbit, 5 forehead, 10 canthus, 4 nasal bridge, 5 cheek, 6 brow, 2 conjunctiva, 1 nasolabial fold and 5 multiple facial location. Fifty (34 %) patients had amblyopia: 27 anisometropia, 8 occlusion, 6 strabismus, 9 combined forms. Of the 33 with some form of anisometropia, all had decreased induced cylinder after treatment. Of those who improved 2 or more diopters of cylinder (21), 7 had steroid injections, 6 had surgical excision, 3 were observed, 1 had oral steroids, and 4 had a combination of treatments. Please see table for additional results.
Each treatment modality, or combination thereof, appeared to yield favorable results, with the vast majority of patients’ lesions regressing. Even in the observation group, all 43 of those who were not documented as regressing , were documented to be free of amblyopia at last follow up. Individualized treatment based on size and location of the lesion, growth pattern and family expectations can lead to favorable visual and cosmetic results in most children.
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