Periocular Capillary Hemangioma: Assessment of Early Treatment on Induced Astigmatism and Visual Acuity

Abstract

Abstract: : Purpose: Assess the change in induced astigmatism and visual acuity with early steroid injection treatment of periocular capillary hemangiomas. Methods: We identified nine infants (mean 5.5 months; range 3–10 months) with periocular capillary hemangioma who were treated for anisometropic astigmatism (mean 4 diopters; range 1.75 – 7.00 diopters) with periocular corticosteroid injection. All of the infants had complete eye examinations including cycloplegic refractions prior to and after the injections. Acuities were assessed using the Teller Acuity Card procedure. Results: Astigmatism was reduced on average 2.6 diopters (mean residual astigmatism 1.4 diopters; range 0 – 3.00 diopters) at last follow–up examination. Four of six infants with pre–injection acuities had the same vision bilaterally; two remaining infants had a one octave acuity difference between eyes. Visual acuities at last examination were equal or differed by less than one octave. Conclusions: Periocular corticosteroid injections given before one year of age reduce astigmatism associated with periocular hemangioma. Astigmatism induced by periocular hemangiomas does not induce significant amblyopia in infancy because the visual blur of immaturity exceeds that of the astigmatism. However, the magnitude of the astigmatism at initial examination is amblyogenic at an older age as refinements in acuity at higher spatial frequency are evolving. Therefore, reduction of astigmatism achieved with periocular corticosteroid injections likely diminishs the risk and severity of amblyopia due to the induced astigmatism.

Keywords: astigmatism