Staged Percutaneous Ultrasound Guided Bleomycin Sclerotherapy Could be a Promising First Line of Treatment for Orbital Lymphatic Malformations in Children

Background: Orbital lymphatic malformations are benign vascular lesions that can be challenging to treat. Although a conservative approach is preferred in small lesion, larger ones may cause amblyopia if treatment is delayed. Surgical debulking is difficult with an associated risk of haemorrhage or collateral damage. We aim to evaluate the effectiveness and safety of ultrasonographic and fluoroscopic guided intra-lesional Bleomycin injection sclerotherapy in cases of orbital lymphatic malformations in children. Methods: In this prospective study, 4 children diagnosed with unilateral orbital lymphatic malformations (from June 2015-February 2016) were subjected to repeated percutaneous ultrasound and flouroscopic guided Bleomycin injections (2000-2500 iu each) after accurate assessment of extent, size and cystic architecture by Magnetic Resonance Imaging (MRI). All children presented with disfiguring proptosis with or without subconjunctival or eyelid extension of the lesion. MRI was repeated after 2 months of injection for radiological assessment. Results: An acceptable clinical improvement of proptosis as well as a diminution in more than 50% of the volume of the lesion by MRI and replacement of the bright signal by low signal ill defined area with the disappearance of cysts was achieved in all subjects after an average of 3 to 6 injections (2 months interval). Except for a transient painful oedema of the periorbital tissue for few days after injection, no major complications were noted. Follow up 8-15 months. Conclusions: Intralesional Bleomycin therapy could be a safe and effective first choice treatment for children with orbital lymphatic malformations.

 

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Publication History

Article published online:
26 April 2021