Tarjani Vivek Dave1,2, Bejjanki Kavya Madhuri3, Srujana Laghmisetty4,5, Devjyoti Tripathy6, Swathi Kaliki5, Suryasnata Rath6, Samir Mohapatra6, Akruti Desai7, Anasua Ganguly Kapoor3. 1. Ophthalmic Plastic Surgery Service, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India. tvdeye@gmail.com. 2. Operation Eyesight Universal Institute for Eye Cancer, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India. tvdeye@gmail.com. 3. Ophthalmic Plastic and Facial Aesthetic, Orbit and Ocular Oncology Service, Kode Venkatadri Chowdary Campus, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India. 4. Ophthalmic Plastic Surgery Service, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India. 5. Operation Eyesight Universal Institute for Eye Cancer, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India. 6. Ophthalmic Plastics, Orbit and Ocular Oncology, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, Odisha, India. 7. Ophthalmic Plastic and Facial Aesthetic, Orbit and Ocular Oncology Service, GMR Varalakshmi Campus, L V Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India.
Abstract
OBJECTIVES: To study the efficacy and the long-term outcomes of treating micro and macrocystic orbital and/or adnexal lymphatic malformations (OA-LM) with protocol-based bleomycin sclerotherapy. METHODS: A retrospective interventional study of 69 eyes having OA-LM treated with non-image guided transcutaneous or transconjunctival bleomycin sclerotherapy (1IU/ml aqueous solution) between December 2014 and December 2018. Based on clinical regression, the outcomes were classified as excellent, good, fair and poor. RESULTS: The mean age at presentation was 20 ± 16 years (median 16; range 1 month to 70 years). The orbital-palpebral variant was the most common presentation, seen in 29 patients (42%). Microcystic morphology was seen in 34(49%), macrocystic in 22 (32%) and mixed cyst in 13 (19%) patients. Mean units of bleomycin injected per patient were 9 ± 8 IU (median 5.5 IU, range 1-38 IU). Mean number of treatment sessions required were 2 ± 1 (median 2, range 1-6). The response was excellent in 43 (62%), good in 12 (17%), fair in 9 (13%) and poor in 5 (7%) patients. These responses were comparable across the morphological subgroups (p = 0.24, chi-square test). Adverse reactions noted were inflammation in 11 eyes (16%) and peri-ocular pigmentation in 15 (22%). There was a sustained tumour regression over a mean follow-up duration of 3.5 years (median 3; range 1.5-5 years). CONCLUSIONS: Seventy-nine percent of eyes with OA-LM showed a good outcome with transcutaneous and/or transconjunctival non-image guided bleomycin sclerotherapy with no serious adverse events. The results were promising over long-term follow-up.
OBJECTIVES: To study the efficacy and the long-term outcomes of treating micro and macrocystic orbital and/or adnexal lymphatic malformations (OA-LM) with protocol-based bleomycin sclerotherapy. METHODS: A retrospective interventional study of 69 eyes having OA-LM treated with non-image guided transcutaneous or transconjunctival bleomycin sclerotherapy (1IU/ml aqueous solution) between December 2014 and December 2018. Based on clinical regression, the outcomes were classified as excellent, good, fair and poor. RESULTS: The mean age at presentation was 20 ± 16 years (median 16; range 1 month to 70 years). The orbital-palpebral variant was the most common presentation, seen in 29 patients (42%). Microcystic morphology was seen in 34(49%), macrocystic in 22 (32%) and mixed cyst in 13 (19%) patients. Mean units of bleomycin injected per patient were 9 ± 8 IU (median 5.5 IU, range 1-38 IU). Mean number of treatment sessions required were 2 ± 1 (median 2, range 1-6). The response was excellent in 43 (62%), good in 12 (17%), fair in 9 (13%) and poor in 5 (7%) patients. These responses were comparable across the morphological subgroups (p = 0.24, chi-square test). Adverse reactions noted were inflammation in 11 eyes (16%) and peri-ocular pigmentation in 15 (22%). There was a sustained tumour regression over a mean follow-up duration of 3.5 years (median 3; range 1.5-5 years). CONCLUSIONS: Seventy-nine percent of eyes with OA-LM showed a good outcome with transcutaneous and/or transconjunctival non-image guided bleomycin sclerotherapy with no serious adverse events. The results were promising over long-term follow-up.
Authors: Alexander L Cho; Sharon C Kiang; Jonathan Lodenkamp; William T H Tritch; Roger T Tomihama Journal: Cardiovasc Intervent Radiol Date: 2020-01-30 Impact factor: 2.740