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TR Shepler, DH Char; Orbital and Eyelid Capillary Hemangiomas: A Retrospective Look at 24 Consecutive Cases . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3039.
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Purpose: To evaluate the different modalities for treating orbital and eyelid capillary hemangiomas including observation, oral and intralesional steroids, and surgery. Methods: Retrospective review of 24 consecutive cases of orbital and eyelid capillary hemangiomas referred to one ophthalmic surgeon (DHC) from 4/80 to 1/00. Variables evaluated included age at diagnosis, sex, visual acuity, prior treatment, indication for treatment, treatment used, outcome, complications, and management of complications. Results: The mean age at diagnosis was 4.9 wks (range 0-26 wks). The mean age at treatment was 3.3 months (range 0.4 - 6 months). Twenty patients had central, steady, and maintained vision. Four patients had central, steady, and unmaintained vision. At time of referral, 17 had no prior treatment, 5 had previous intralesional steroids, and 2 had prior oral steroid treatment. Indications for further treatment included amblyopia (12/18), proptosis (6/18), ptosis (3/18), esotropia (1/18), entropion (1/18), and cosmetic (1/18). Treatment modalities included observation (9/24), intralesional steroids (8/24), surgery (7/24), and oral steroids (1/24). All patients in the oral and intralesional steroid group, 7 of 9 in the observation group, and 5 of 7 in the surgery group had complete or partial resolution. Two patients in the observation group were unchanged. There were no complications reported in the observation group. One patient in the intralesional steroid group had anisometropic amblyopia causing 20/30 vision. Three patients in the surgery group developed complications. One patient had pressure necrosis and recurrence of the hemangioma that was managed with observation only. One patient developed a recurrence of the hemangioma that was managed with a second surgery. One patient developed ptosis that was repaired, but went onto develop esotropia and amblyopia with CF vision. The mean length of follow-up was 19.3 months (range 1.0 - 113.0 months). Conclusions: Observation, oral and intralesional corticosteroids, and surgery can all effectively result in complete or partial resolution of orbital and eyelid capillary hemangiomas. A stepwise approach to management should be employed. Most patients with normal visual acuity can be managed with observation. Patients in whom the visual acuity is decreased or the visual axis is interrupted should have a trial of oral or intralesional steroid treatment. If this treatment fails or the lesion appears to be unamenable to steroids, then surgery should be considered. While surgery can have complications, most complications can be managed effectively without any permanent sequela.
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