Levi Michelle, Schwartz Shirah, Blei Francine, Ceisler Emily, Steele Mark, Furlan Louis, Millman Arthur, Kodsi Sylvia R
Department of Ophthalmology, North Shore-Long Island Jewish Health System, Great Neck, New York, USA.
J AAPOS. 2007 Jun;11(3):230-4. doi: 10.1016/j.jaapos.2006.12.048. Epub 2007 Mar 7.
Capillary hemangiomas of the eyelids and orbit can cause refractive and occlusive amblyopia. Although oral and intralesional steroid injections are the most common treatment modalities, sometimes they are not successful. There is a paucity of information in the literature on the success of eliminating amblyogenic factors by treating these lesions with surgical resection.
Retrospective chart review of 10 patients in two pediatric ophthalmology practices who underwent surgical excision of a capillary hemangioma that was causing amblyopia and that had failed to regress with other treatment.
Two patients had surgery secondary to pupillary occlusion, which was successful in relieving occlusion. Eight patients had surgery secondary to significant astigmatism. The average preoperative astigmatic difference between the affected and unaffected eye in five of these patients undergoing surgery before the age of 21 months was 2.15 D. The average postoperative astigmatic difference was 0.1 D. The average preoperative astigmatic difference between the affected and unaffected eye in three patients undergoing surgery after 21 months of age was 1.6 D. Surgery completely failed to reduce the astigmatism in two of these patients. The third patient had a decrease of 0.75 D of cylinder but still had a difference of 1.75 D between the two eyes postoperatively. Postoperative complications in this study included wound infection in one patient.
Surgical excision of capillary hemangiomas that were resistant to other modes of treatment was useful in relieving pupillary occlusion and in decreasing the amount of astigmatism if performed before the age of 21 months in our series of patients. Our cases as well as the literature suggest that surgery should be performed at 13 months or earlier to reduce the amount of astigmatism.
眼睑和眼眶的毛细血管瘤可导致屈光性和闭塞性弱视。尽管口服和病灶内注射类固醇是最常见的治疗方式，但有时并不成功。关于通过手术切除这些病变来消除致弱视因素的成功率，文献中资料匮乏。
对两家儿科眼科诊所的10例患者进行回顾性病历分析，这些患者因毛细血管瘤导致弱视且其他治疗方法未能使其消退，故而接受了手术切除。
2例患者因瞳孔闭塞而接受手术，手术成功解除了闭塞。8例患者因明显散光而接受手术。在21个月龄前接受手术的5例患者中，患眼与未患眼术前平均散光差异为2.15 D。术后平均散光差异为0.1 D。在21个月龄后接受手术的3例患者中，患眼与未患眼术前平均散光差异为1.6 D。其中2例患者手术完全未能降低散光。第3例患者柱镜度数降低了0.75 D，但术后两眼仍有1.75 D的差异。本研究中的术后并发症包括1例患者发生伤口感染。
在我们的系列患者中，如果在21个月龄前进行手术切除，对其他治疗方式耐药的毛细血管瘤在缓解瞳孔闭塞和减少散光量方面是有效的。我们的病例以及文献表明，手术应在13个月或更早进行，以减少散光量。
