Surgical treatment of capillary hemangiomas causing amblyopia.
BACKGROUND
Capillary hemangiomas of the eyelids and orbit can cause refractive and occlusive amblyopia. Although oral and intralesional steroid injections are the most common treatment modalities, sometimes they are not successful. There is a paucity of information in the literature on the success of eliminating amblyogenic factors by treating these lesions with surgical resection.


METHODS
Retrospective chart review of 10 patients in two pediatric ophthalmology practices who underwent surgical excision of a capillary hemangioma that was causing amblyopia and that had failed to regress with other treatment.


RESULTS
Two patients had surgery secondary to pupillary occlusion, which was successful in relieving occlusion. Eight patients had surgery secondary to significant astigmatism. The average preoperative astigmatic difference between the affected and unaffected eye in five of these patients undergoing surgery before the age of 21 months was 2.15 D. The average postoperative astigmatic difference was 0.1 D. The average preoperative astigmatic difference between the affected and unaffected eye in three patients undergoing surgery after 21 months of age was 1.6 D. Surgery completely failed to reduce the astigmatism in two of these patients. The third patient had a decrease of 0.75 D of cylinder but still had a difference of 1.75 D between the two eyes postoperatively. Postoperative complications in this study included wound infection in one patient.


CONCLUSIONS
Surgical excision of capillary hemangiomas that were resistant to other modes of treatment was useful in relieving pupillary occlusion and in decreasing the amount of astigmatism if performed before the age of 21 months in our series of patients. Our cases as well as the literature suggest that surgery should be performed at 13 months or earlier to reduce the amount of astigmatism.
Levi
Michelle
M
Department of Ophthalmology, North Shore-Long Island Jewish Health System, Great Neck, New York, USA.
Schwartz
Shirah
S
Blei
Francine
F
Ceisler
Emily
E
Steele
Mark
M
Furlan
Louis
L
Millman
Arthur
A
Kodsi
Sylvia R
SR
D000550:Amblyopia / Q000209:etiology*; D005142:Eyelid Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D005865:Gestational Age; D018324:Hemangioma, Capillary / Q000150:complications / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D013508:Ophthalmologic Surgical Procedures; D009918:Orbital Neoplasms / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies