title: Surgical treatment of capillary hemangiomas causing amblyopia.
abstract: 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.
authors.affiliation: Department of Ophthalmology, North Shore-Long Island Jewish Health System, Great Neck, New York, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Levi
authors.forename: Shirah
authors.initials: S
authors.lastname: Schwartz
authors.forename: Francine
authors.initials: F
authors.lastname: Blei
authors.forename: Emily
authors.initials: E
authors.lastname: Ceisler
authors.forename: Mark
authors.initials: M
authors.lastname: Steele
authors.forename: Louis
authors.initials: L
authors.lastname: Furlan
authors.forename: Arthur
authors.initials: A
authors.lastname: Millman
authors.forename: Sylvia R
authors.initials: SR
authors.lastname: Kodsi
mesh_terms: 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