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Correspondence to Dr Jiang Qian, Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Rd, Shanghai 200031, China; [email protected]
Introduction
Vascular malformations are among the most common space-occupying lesions of the orbit. They often result in proptosis, pain, swelling, motility disturbances, visual impairment and disfigurement. Orbital vascular malformations comprise a wide spectrum of abnormalities, which may exhibit various combinations of venous, arterial or lymphatic differentiation. Currently, orbital vascular abnormalities are treated in a multidisciplinary fashion, including surgical excision, selective embolisation, laser therapy, sclerotherapy, etc.1 The therapeutic choice for each patient depends on the site and size of lesions, hemodynamics, type of abnormality, and surgeon preference.
The treatment of orbital vascular malformations remains challenging because many are difficult to surgically resect due to their sheer size and their permeation of orbital structures, including extraocular muscles, motor and sensory nerves, and the optic nerve. They are particularly difficult to resect when located deep in the orbital apex where excision may be complicated by severe haemorrhage in addition to damage to the aforementioned structures. Lasers are only appropriate for superficial malformations whereas radiotherapy is a poor choice due to the relative resistance of these lesions to radiotherapy, radiotoxicity to normal structures, and cosmetic complications. Embolisation also has significant drawbacks due to potential infarction of normal structures with loss of visual function, inconsistent efficacy and shunting of flow following embolisation.2
Because of these drawbacks, direct puncture sclerotherapy has been proposed as a minimally invasive treatment option for these cases.3 4 Of the available sclerosing agents, pingyangmycin (bleomycin A5) has proved to be safe and effective in the treatment of vascular malformations of the head and neck.5–8 We report our experience using intralesional pingyangmycin treatment for orbital venous and lymphatic malformations, including orbital cavernous haemangiomas.9 10 To measure the efficacy in a quantitative fashion, we analysed preinjection and postinjection CT scans with graphic processing software to measure lesional volume reduction after a single injection of pingyangmycin. In one case, we also examined the histopathologic features of a cavernous haemangioma following injection with the drug.
Methods
Patient and diagnosis
This is an interventional case series of 13 patients with orbital vascular malformations. These patients underwent sclerotherapy treatment with intralesional injection of pingyangmycin (Tianjin...