Barnacle Alex M, Theodorou Maria, Maling Sarah J, Abou-Rayyah Yassir
Department of Radiology, Great Ormond Street Hospital for Children, London, UK.
Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK.
Br J Ophthalmol. 2016 Feb;100(2):204-8. doi: 10.1136/bjophthalmol-2015-306657. Epub 2015 Jun 17.
Percutaneous sclerotherapy is an alternative to surgery for the treatment of orbital lymphatic malformations (LMs). We present a large series of patients undergoing sclerotherapy for macrocystic LMs with detailed visual acuity (VA) outcome data.
Data were collected prospectively in all patients with macrocystic orbital LMs undergoing sclerotherapy. Sclerotherapy was performed under general anaesthesia, instilling sodium tetradecyl sulfate under imaging control. Procedures were repeated at 2-week to 6-week intervals, depending on clinical response. Patients underwent ophthalmological assessment, ultrasound and/or MRI before and after treatment.
change in maximal radiological diameter of the LM.
change in VA after treatment.
29 patients underwent 71 procedures (1-8 procedures per patient) over 6.7 years. Mean age=7.31 years. 11 patients (37.9%) had undergone previous treatment, including excision biopsy, drainage and decompression. All patients presented with proptosis and/or pseudoptosis. 23 patients (79.3%) had decreased VA at presentation. Average follow-up was 21.8 months (range 3-75 months). All patients achieved a reduction in maximal lesion diameter of ≥50%, with complete radiological resolution in 51.7% (n=15). VA improved in 18/23 patients (78.2%). Average logMAR before treatment=0.43 (SD ±0.47); average after treatment=0.25 (SD ±0.32); p<0.01. There was one complication (1.4%): one patient required a lateral canthotomy for an intralesional haematoma 2 h after sclerotherapy.
Sclerotherapy is a safe and highly effective treatment for orbital LMs with excellent VA outcomes. It should be considered as the first-line treatment for this condition.
经皮硬化治疗是治疗眼眶淋巴管瘤（LM）的一种手术替代方法。我们报告了一大系列接受硬化治疗的大囊型LM患者，并提供了详细的视力（VA）结果数据。
前瞻性收集所有接受硬化治疗的大囊型眼眶LM患者的数据。硬化治疗在全身麻醉下进行，在影像引导下注入十四烷基硫酸钠。根据临床反应，每隔2周或6周重复进行治疗。患者在治疗前后接受眼科评估、超声和/或磁共振成像检查。
LM最大放射学直径的变化。
治疗后VA的变化。
29例患者在6.7年期间接受了71次治疗（每位患者1 - 8次治疗）。平均年龄为7.31岁。11例患者（37.9%）曾接受过包括切除活检、引流和减压在内的先前治疗。所有患者均表现为眼球突出和/或假性眼球突出。23例患者（79.3%）在就诊时视力下降。平均随访时间为21.8个月（范围3 - 75个月）。所有患者的最大病变直径均缩小≥50%，51.7%（n = 15）的患者放射学上完全消退。23例患者中有18例（78.2%）视力得到改善。治疗前平均对数最小分辨角（logMAR）为0.43（标准差±0.47）；治疗后平均为0.25（标准差±0.32）；p<0.01。发生1例并发症（1.4%）：1例患者在硬化治疗后2小时因病灶内血肿需要行外眦切开术。
硬化治疗是一种安全有效的眼眶LM治疗方法，视力预后良好。应将其视为该病的一线治疗方法。
