Oyama Tokuhide, Eguchi Koichi, Cho Hiroyuki, Abe Haruki
Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahi-machi, Niigata-shi 951-8510, Japan.
Nippon Ganka Gakkai Zasshi. 2009 Jul;113(7):732-40.
Orbital lymphangioma can result in ocular emergencies due to acute enlargement, leading to painful proptosis, compressive optic neuropathy, exposure keratopathy, restrictive ocular motility and increased intraocular pressure. Treatment methods and clinical courses of two cases with orbital lymphangioma are reported, one with orbital decompression therapy and the other with intralesional injection of OK-432 therapy. CASE 1: An 8-year-old girl had multilocular cystic orbital intracornal lymphangioma. Emergency operation was deemed necessary because the patient presented with the painful proptosis, the compressive optic neuropathy, and increased intraocular pressure due to acute enlargement, we put the orbital inferior wall was decompressed by inserting an intact inframedial orbital strut. The proptosis vanished completely and visual acuity loss improved. CASE 2: A 2-year-old girl had multilocular cystic orbital intra and extracornal lymphangioma. She had severe proptosis and exposure keratopathy. The extracornal cystic lesion was treated with an intralesional injection of OK-432. On the 7th day after injection, the patient presented with painful severe proptosis. Aspiration of the fluid in the cystic lesion was performed, and the drain was preserved. After the treatment, both the severe proptosis and the exposure keratopathy improved.
Inferior wall decompression was performed on case 1 while keeping the inframedial orbital strut. Although the eye movement disorder was low at the time, the medial and lateral wall decompression improved. In case 2, the extracornal cystic lesion was treated with an intralesional injection of OK-432 Judging from the results of that clinical course, the injection of OK-432 to the intracornal lesion could prove dangerous to the visual performance. Although OK-432 is predictably-effective against lymphangioma, it should not perform be applied without careful consideration.
眼眶淋巴管瘤可因急性增大导致眼部急症，引起疼痛性眼球突出、压迫性视神经病变、暴露性角膜病变、限制性眼球运动障碍及眼压升高。本文报道两例眼眶淋巴管瘤的治疗方法及临床过程，一例采用眼眶减压治疗，另一例采用瘤内注射OK-432治疗。病例1：一名8岁女孩患有多房性眶内淋巴管瘤。由于患者因急性增大出现疼痛性眼球突出、压迫性视神经病变及眼压升高，急诊手术被认为必要，我们通过插入完整的眶内侧支柱对眶下壁进行减压。眼球突出完全消失，视力丧失有所改善。病例2：一名2岁女孩患有多房性眶内及眶外淋巴管瘤。她有严重的眼球突出和暴露性角膜病变。对眶外囊性病变采用瘤内注射OK-432治疗。注射后第7天，患者出现疼痛性严重眼球突出。对囊性病变内的液体进行抽吸，并保留引流管。治疗后，严重眼球突出和暴露性角膜病变均有所改善。
病例1在保留眶内侧支柱的情况下对下壁进行减压。虽然当时眼球运动障碍程度较低，但内侧和外侧壁减压有所改善。在病例2中，对眶外囊性病变采用瘤内注射OK-432治疗。从该临床过程的结果判断，向眶内病变注射OK-432可能对视觉功能有危险。虽然OK-432对淋巴管瘤可预见地有效，但不应在未经仔细考虑的情况下应用。
