Parenteral corticosteroids followed by early surgical resection of large amblyogenic eyelid hemangiomas in infants

Abstract

BackgroundThe purpose of this study was to evaluate the results and complications of early surgical resection of large amblyogenic subdermal eyelid hemangiomas in infants after prior short-term parenteral administration of corticosteroids.MethodsSixteen infants were given dexamethasone 2 mg/kg/day in two divided doses for three consecutive days prior to scheduled surgical excision of large eyelid hemangiomas. The lesions were accessed via an upper eyelid crease, subeyebrow incision, or a lower eyelid subciliary incision.ResultsIn all cases, surgical excision of the entire lesion was possible with no significant intraoperative or postoperative complications. The levator muscle/aponeurosis complex was involved in 31.25% of cases and was managed by reinsertion or repositioning without resection. A satisfactory lid position and contour with immediate clearing of the visual axis was achieved in all but one case (93.8%).ConclusionParenteral corticosteroids helped in reducing volume and blood flow from the hemangiomas, allowing for very early total excision of large subdermal infantile hemangiomas without significant intraoperative hemorrhage. This resulted in immediate elimination of any reason for occlusion amblyopia. Long-term follow-up of visual development in these patients would help to demonstrate the effectiveness of this strategy compared with more conservative measures.

Effectiveness and safety of polidocanol for the treatment of hemangiomas and vascular malformations: A meta-analysis

“…Most HMs disappear without treatment, leaving minimal or no visible marks. Surgical removal is sometimes indicated, particularly if there has been delay in commencing treatment and if structural changes have become irreversible (Essawy & Galal, 2013). Until recently, the mainstay of treatments include the systematic use of corticosteroids (Nieuwenhuis, de Laat, Janmohamed, Madern, & Oranje, 2013) and beta-blockers (Petrovic et al, 2017), the intralesional injection of corticosteroid (Chantharatanapiboon, 2008; Prasetyono & Djoenaedi, 2011) and antitumor drugs (Hou, Wang, Tang, Wang, & Huang, 2011;Wang et al, 2009), the topical use of betablockers (Mashiah et al, 2017;Schneider, Reimer, Cremer, & Ruef, 2014;Wang et al, 2017) and 5% imiquimod (Ho, Lansang, & Pope, 2007;Ma et al, 2011;Welsh, Olazar an, G omez, Salas, & Berman, 2004), and lasers (Li, Hu, Li, & Deng, 2016;Ying et al, 2017).…”

“…Until recently, the mainstay of treatments include the systematic use of corticosteroids (Nieuwenhuis, de Laat, Janmohamed, Madern, & Oranje, 2013) and beta-blockers (Petrovic et al, 2017), the intralesional injection of corticosteroid (Chantharatanapiboon, 2008;Prasetyono & Djoenaedi, 2011) and antitumor drugs (Hou, Wang, Tang, Wang, & Huang, 2011;Wang et al, 2009), the topical use of betablockers (Mashiah et al, 2017;Schneider, Reimer, Cremer, & Ruef, 2014;Wang et al, 2017) and 5% imiquimod (Ho, Lansang, & Pope, 2007;Ma et al, 2011;Welsh, Olazar an, G omez, Salas, & Berman, 2004), and lasers (Li, Hu, Li, & Deng, 2016;Ying et al, 2017). Surgical removal is sometimes indicated, particularly if there has been delay in commencing treatment and if structural changes have become irreversible (Essawy & Galal, 2013). It has been reported that sclerotherapy with ethanol (Muto, Kinehara, Takahara, & Sato, 1990;Szejnfeld et al, 2015), sodium tetradecyl sulfate (Damodaran, McAuliffe, Wong, McCloskey, & Lee, 2012), and polidocanol (lauromacrogol 400; Winter, Dräger, & Sterry, 2000) is an easy, safe, and effective modality for localized lesions.…”