Ultrasonographically guided injection of corticosteroids for the treatment of retroseptal capillary hemangiomas in infants (original) (raw)

1997, Journal of American Association for Pediatric Ophthalmology and Strabismus

Purpose: Injection of corticosteroids is a well-documented and successful mode of treatment for periorbital capillary hemangiomas. Because of the greater potential risk involved with retrobulbar injections, no prior study has described this treatment for tumors located behind the orbital septum. Although retroseptal intraorbital capillary hemangiomas comprise only7% of all adnexal capillary hemangiomas, complications such as optic nerve compression or astigmatism may necessitate treatment. Methods:Three patients with deep orbital hernangiomas that caused vision-threatening complications were treated with intralesional injections of triamcinolone and betamethasone. Orbital injection was performed with use of real-time ultrasonographic guidance of the needle. This technique was valuable in providing continuous, accurate, and safe advancement ofthe needle tip in the orbit to avoid the globe and orbital walls. Ultrasonography also permitted precise placement of the needle tip within the tumor and visualization of the injected material.Results:Significant improvement was demonstrated in all cases on the basis of both ultrasonographic measurements and regression of clinical manifestations such as astigmatism, chemosis, proptosis, and optic nerve pallor. No complications were noted. Conclusion: Intralesional injection of corticosteroids to treat retroseptal and retrobulbar capillary hemangiomas was found to be a safe and effective treatment modality in our patients. Positioning of the injecting needle was guided by ultrasonography. (J AAPOS 1997;1:34-40) A dnexal and orbital capillary hemangiomas account for 10% of all orbital tumors in children. I, 2 These benign tumors tend to grow during the first postnatal year, stabilize in size when the patient is 12 to 18 months of age, and then gradually shrink. Forty percent of hemangiomas disappear by the time the patient is 4 years old, and 70% disappear by the time the patient is 7 years old. 3 Because these rumors have a high incidence of spontaneous regression, treatment is usually indicated only for the prevention of complications that threaten vision. The vision-threatening complications that occur most frequently are amblyopia resulting from ptosis and astigmatism. 4-6 Significant asymmetric astigmatism and vision-threatening ptosis have therefore been considered indications for treatment, with documented reversal of the astigmatism, ptosis, and amblyopia. 4, 7