Hanif Adam M, Saunders Justin A, Hawkins C Matthew, Wojno Ted H, Kim Hee Joon
a Department of Ophthalmology , Emory University School of Medicine , Atlanta , GA , USA.
b Department of Radiology and Imaging Sciences , Emory University Hospital , Atlanta , GA , USA.
Orbit. 2019 Feb;38(1):30-36. doi: 10.1080/01676830.2018.1480636. Epub 2018 Jun 14.
Bleomycin sclerotherapy has been shown to be a viable treatment for lymphatic malformations. However, its use for these lesions confined to the orbit is becoming increasingly documented in the literature. In this study, we summarize the clinical manifestations and outcomes observed following percutaneous bleomycin sclerotherapy for orbital lymphatic malformation.
A 5-year retrospective chart review of patients with clinical, radiographic, and/or biopsy-confirmed diagnoses of orbital lymphatic malformation that received bleomycin sclerotherapy was conducted at the Emory Hospital and Clinics. Data examined included patient demographics, patient history and symptoms, clinical findings, radiographic findings, route of bleomycin delivery, and outcome.
Of the 10 patients who met inclusion criteria, the median age of treatment was 7 years. The most common presenting symptoms included vision change and proptosis. Nine of 10 patients demonstrated macrocysts (>1 cm) on imaging. Seven of 10 patients had histories of prior interventions including resections, cyst drainage, and debulking. Because 2 of these 10 patients were lost to follow-up, 8 patients remained for post-procedural evaluation. Four of these eight showed improvement of visual acuity after post-bleomycin sclerotherapy. In seven of eight patients, extraocular motility either improved or remained stable. Pretreatment and posttreatment exophthalmometer measurements obtained in four patients revealed an average improvement in proptosis of 65% from their average pretreatment measurements.
Our findings suggest that percutaneous bleomycin sclerotherapy is a viable option for treatment of orbital lymphatic malformations, with potentially greater benefit to those with macrocystic features.
博来霉素硬化疗法已被证明是治疗淋巴管畸形的一种可行方法。然而，其用于眼眶局限性病变的情况在文献中的记载越来越多。在本研究中，我们总结了经皮注射博来霉素硬化治疗眼眶淋巴管畸形后的临床表现及治疗效果。
在埃默里医院及诊所对临床、影像学和/或活检确诊为眼眶淋巴管畸形并接受博来霉素硬化治疗的患者进行了为期5年的回顾性病历审查。审查的数据包括患者人口统计学资料、病史和症状、临床检查结果、影像学检查结果、博来霉素给药途径及治疗效果。
符合纳入标准的10例患者中，治疗的中位年龄为7岁。最常见的症状包括视力改变和眼球突出。10例患者中有9例在影像学检查中显示有大囊肿（>1cm）。10例患者中有7例曾接受过包括切除、囊肿引流和减瘤手术在内的先前干预。由于这10例患者中有2例失访，8例患者接受了术后评估。这8例患者中有4例在博来霉素硬化治疗后视力有所改善。8例患者中有7例的眼外肌运动功能有所改善或保持稳定。4例患者治疗前和治疗后的眼球突出度测量结果显示，与治疗前平均测量值相比，眼球突出平均改善了65%。
我们的研究结果表明，经皮注射博来霉素硬化疗法是治疗眼眶淋巴管畸形的一种可行选择，对具有大囊状特征的患者可能更有益。
