Image-Guided Percutaneous Sclerotherapy of Orbital Low-Flow Vascular Malformations

Objectives: To evaluate the effectiveness and safety of percutaneous sclerotherapy using bleomycin for orbital low flow vascular malformations. Methods: Between October 2015 and August 2019, we prospectively evaluated 24 patients who clinically and radiologically diagnosed with orbital low-flow vascular malformations. Sixteen females and eight males were included in the study, ranging in age from 3 to 46 years (mean: 13.4 ± 10.3). Twenty-two patients presented with proptosis and limited ocular motility, 15 patients with dystopia, and 2 patients with amblyopia and exposure keratitis. Ophthalmological assessment, ultrasound, and magnetic resonance imaging were performed before and 6 weeks after treatment. Under general anesthesia, orbital lesions were punctured guided by ultrasound, fluoroscopy, and cone-beam computed tomography. Before sclerotherapy, small volume of Omnipaque was injected to exclude vascular communication or contrast leakage, and then bleomycin was instilled. Procedures were repeated at 8-week intervals, depending on clinical and radiological response. The follow-up period ranged from 3 to 40 months, with a mean: 19.5 ± 12.4. Results: Fifteen patients were diagnosed with lymphatic malformations, and nine patients with venous malformations. Forty-one sclerotherapy sessions were performed (range: 1–3, mean: 1.7 ± 0.8). Bleomycin dose ranged 2–20 IU (mean 7.2 ± 4.6). Clinically, there was a significant reduction in the degree of proptosis (P = 0.001) and dystopia (P = 0.002), with no significant changes in the visual acuity. Radiologically, there was significant reduction in the maximum lesions diameters and volumes (P = 0.001 and P = 0.005, respectively). Transient pain, edema, and ecchymosis occurred following the procedure with no major complications encountered. Conclusion: Intralesional bleomycin therapy could be a safe and effective treatment for orbital low-flow vascular malformations with low rate of complications.

Publication History

Article published online:
26 April 2021