Cohen Liza M, Goldberg Robert A, Rootman Daniel B
Division of Orbital and Ophthalmic Plastic Surgery, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, U.S.A.
Ophthalmic Plast Reconstr Surg. 2022;38(3):283-288. doi: 10.1097/IOP.0000000000002085. Epub 2021 Nov 16.
Treatment for orbital venolymphatic malformations (VLMs) commonly includes 3 major options: sclerotherapy, surgery, and embolization followed by surgical excision. Each has certain advantages, although it is not clear whether all are effective. The authors characterize the clinical course for a series of patients with distensible orbital venous-dominant VLM treated with sclerotherapy and/or embolization with excision.
In this cross-sectional cohort study, patients affected by distensible orbital venous-dominant VLM presenting to the orbital and ophthalmic plastic surgery service from 2014 to 2020 were identified. Patients were included if they presented with a moderate-flow, distensible venous-dominant malformation associated with Valsalva-related symptoms (e.g., pain, proptosis, and diplopia).
Six cases were treated with sclerotherapy. Four underwent multiple treatments, with a mean ± SD of 3.5 ± 2.3 (range 1-7). All patients in this group failed to improve or experienced recurrence of symptoms after sclerotherapy. Twelve cases were treated with embolization and excision. Resolution of symptoms in all 12 cases was noted and maintained for a mean of 3.4 ± 2.1 years. There have been no cases of recurrence. Patients treated with sclerotherapy were more likely to experience recurrence of symptoms compared to those treated with embolization and excision (p < 0.001).
Treatment of distensible venous-dominant moderate-flow orbital VLM with sclerotherapy may provide temporary improvement in some cases. However, in the medium to long term, recurrence was universal in this series. Embolization with excision appears to provide more definitive management, avoiding recurrence in all cases for a mean follow-up of 3 years.
眼眶静脉淋巴管瘤（VLM）的治疗通常包括三种主要选择：硬化治疗、手术以及栓塞后手术切除。每种方法都有一定优势，尽管其是否全部有效尚不清楚。作者描述了一系列采用硬化治疗和/或栓塞联合切除的可扩张性眼眶静脉为主型VLM患者的临床病程。
在这项横断面队列研究中，确定了2014年至2020年期间到眼眶及眼科整形手术科室就诊的可扩张性眼眶静脉为主型VLM患者。如果患者表现为中等血流、可扩张的静脉为主型畸形并伴有瓦尔萨尔瓦动作相关症状（如疼痛、眼球突出和复视），则纳入研究。
6例患者接受了硬化治疗。4例接受了多次治疗，平均±标准差为3.5±2.3次（范围1 - 7次）。该组所有患者在硬化治疗后症状未改善或复发。12例患者接受了栓塞和切除治疗。所有12例患者的症状均得到缓解并维持了平均3.4±2.1年。无复发病例。与接受栓塞和切除治疗的患者相比，接受硬化治疗的患者更易出现症状复发（p < 0.001）。
采用硬化治疗可扩张性静脉为主型中等血流眼眶VLM在某些情况下可能会提供暂时改善。然而，从中长期来看，该系列中复发情况普遍。栓塞联合切除似乎能提供更确切的治疗，在平均3年的随访中所有病例均未复发。
