Intralesional and sub-Tenon's infusion of corticosteroids for treatment of refractory periorbital and orbital capillary haemangioma

Abstract

Purpose To evaluate the effect of combined intralesional and sub-Tenon's administration of corticosteroids for the treatment of refractory periocular and orbital capillary haemangioma in a retrospective, noncomparative study. Methods Seven infants with resistant periorbital and orbital capillary haemangioma who attended our tertiary centre from 2000 to 2005 were treated with an intralesional injection of a mixture of betamethasone 6 mg/cc and triamcinolone 10 mg/cc, by body weight, together with sub-Tenon's infusion of betamethasone 6 mg/cc and triamcinolone 40 mg/cc of a volume of 1 cc, close to the orbital lesion, in the same session. Visual axis, proptosis, pre-and post-treatment changes in four refractive parameters, and parental satisfaction were evaluated. Results None of the babies had proptosis or visual axis obstruction after treatment. Mean spherical power decreased by 22.7% (P ¼ 0.06). Mean spherical equivalent decreased in 34%, but the difference was not statistically significant (P ¼ 0.09). No early or late ocular side effects were observed. Mean intraocular pressure results were normal before and immediately after treatment, and during the follow-up period. Parental satisfaction score during follow-up was 9/10. Mean time to improvement was 96.43 ± 58.3 days. Conclusions Combined local corticosteroid administration by posterior sub-Tenon's infusion and intralesional injection in babies with extensive capillary haemangioma is associated with a satisfactory anatomical and functional outcome and there were no ophthalmic side effects.

Periocular capillary hemangiomas: Indications and options for treatment

“…Injection can be used most easily with anterior lesions or after biopsy or partial excision of deeper orbital tumors. There have also been descriptions of techniques involving sub-Tenons injection along with injection of the hemangioma, with satisfactory results 21. For intralesional injection, Kushner recommends 40 mg of triamcinolone acetate and 6 mg preparation of betamethasone acetate and betamethasone phosphate, with a total injection volume of 1-2 ml.…”

Refractive and structural changes in infantile periocular capillary haemangioma treated with propranolol

“…16,17 First-line therapy with corticosteroids: systemic (oral and intravenous), through local intralesional injection, periorbital infusion, or combined intralesional and posterior sub-Tenon's infusion yielded anatomical and refractive improvement. [18][19][20] However, prolonged treatment with several sessions sometimes required general anaesthesia for proper administration, and posed a risk of serious ocular and systemic side effects. 21 In cases of steroid-resistant lesions, second-line therapy with interferon-á and vincristine had an almost 100% success rate, but adverse reactions ranged from minor to very severe.…”

Treatment of periorbital infantile haemangiomas: A systematic literature review on propranolol or steroids

“…All included studies were case series, among which 15 involved propranolol therapy and 16 used corticosteroids. Twenty‐six studies examined response rates, 12 reported rebound growth rates, 13 analysed spherical power, 14 studies surveyed cylinder power, 16 looked at amblyopia rates after treatment and 21 reported adverse events . Because all of the included studies were observational studies, the MINORS score was applied to define the quality of evidence.…”

“…In the steroid groups, the most common treatment was intralesional injection of a combination of triamcinolone (40 mg) and betamethasone/dexamethasone (46 mg) . A second or third injection was necessary when the size of the lesion was insufficiently reduced.…”