Original article
Sclerosing Therapy as First Line Treatment for Low Flow Vascular Lesions of the Orbit

https://doi.org/10.1016/j.ajo.2005.09.026Get rights and content

Purpose

To evaluate the outcome of sodium morrhuate 5% injections in patients with low flow vascular lesions, which consist of orbital lymphangiomas, and in one patient with intraosseous cavernous hemangioma.

Design

Prospective, interventional consecutive case series.

Methods

Intralesional sodium morrhuate 5% was injected under direct visualization or under radiographic guidance to six patients with orbital lymphangiomas and one patient with intraosseous cavernous hemangioma. Comprehensive eye examination and follow-up imaging studies were performed. main outcome measures: Lesion size was evaluated by orbital imaging and clinical examination, visual acuity, exophthalmos, and posttreatment complications.

Results

Seven patients (four female, three male; average age, 33 years) were included. Six patients were diagnosed with orbital lymphangioma, and one patient was diagnosed with intraosseous cavernous hemangioma. Patients received an average of 2.6 ± 2 intralesional injections of sodium morrhuate, with a range of one to six injections and a mean volume of 0.9 ± 0.8 ml (range, 0.2 to 2.1 ml). Lesions showed a decrease in size an average of 50% (33%) and ranged from minimal (10%) to near total resolution (85%). Visual acuity and intraocular pressure remained unchanged; exophthalmos decreased an average of 1.5 ± 1.8 mm. Complications included one case of orbital hemorrhage that resolved spontaneously and transient keratopathy in all patients with anterior orbital lesions.

Conclusion

Intralesional sclerosing therapy with sodium morrhuate 5% is effective in tumor debulking in patients with orbital lymphangioma and is not associated with vision-threatening complications. It may be a better alternative to surgery for low flow orbital tumors, which includes lymphangioma.

Section snippets

Material and methods

A prospective study of six patients with clinically or radiographically significant orbital lymphangiomas and one patient with cavernous hemangioma of the bone at the Jules Stein Eye Institute was conducted from January 2001 to July 2004. Patients were given 0.1-ml aliquots of sodium morrhuate 5% intralesionally or into the lymphatic cystic spaces to debulk the tumor in a nonsurgical manner. The main outcome measures for comparison purposes were lesion regression that was evident by clinical

Results

Seven patients (three male, four female; mean age, 33 years) were followed after sclerosing therapy for orbital lymphangioma (six patients) or intraosseous hemangioma (one patient); the mean duration of orbital tumor was 17 months. Six patients underwent previous debulking of lesion (one of these patients underwent four surgeries and required a skin graft); in one patient, no previous treatment was performed. Three of the six patients with anteriorly presenting orbital lymphangiomas had a

Discussion

Seven patients with low flow orbital vascular tumors were treated nonsurgically by intralesional injections of sodium morrhuate 5%. The outcome displayed an obvious improvement of these tumors.

Low flow vascular tumors can be difficult to treat and often bleed excessively at the time of surgery, with a high recurrence rate. Often these lesions are cosmetically unpleasing and demonstrate destruction of adjacent tissues. Surgical debulking of these lesions may result in marked disfigurement.

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