The effect of intralesional steroid injections on the volume and blood flow in periocular capillary haemangiomas.
OBJECTIVE
To examine the effect of steroid therapy on the volume estimates and blood flow characteristics of childhood periorbital capillary haemangiomas.


METHODS
Children at risk of amblyopia due to periorbital haemangiomas were treated with intralesional steroid injections (between 1 and 4 courses) and serial assessment of the volume and blood-flow characteristics of the lesions measured using colour Doppler ultrasonography. The characteristics of the haemangiomas in these children were compared with a cohort of untreated cases.


RESULTS
Eight of nine treated children were female, this proportion being significantly different from the equal sex distribution of an untreated cohort (p < 0.05). All children in the steroid-treated group presented within 1 month of birth, compared to the untreated children, who presented at an average of 2.1 months of age (range 0-14, median 2.9 months) (p = 0.04) and they required significantly longer follow-up in the Orbital service (mean 65 months, range 26-105), compared with an average of 35 months (range 4-92, median 23) in the untreated group (p = 0.002). The maximum estimated volume of the lesions were significantly larger in the treated group (treated group mean 8.9 ml, untreated group mean 4.1 ml; p = 0.016), with a trend towards higher maximum measured blood velocities in the treated group (treated mean 64 cm compared with untreated mean 52 cm; p = 0.1). Steroid injections appear to reduce the volume and blood flow of haemangiomas, this suppression persisting for several months (between 5 and 20) before the lesion later displays the cyclic fluctuations in volume and flow seen with untreated lesions. All treated haemangiomas had some residual vascular anomaly, detectable on ultrasonography, at last follow-up--this being despite absence of clinical signs in most cases.


CONCLUSIONS
Periorbital capillary haemangiomas requiring steroid therapy for risk of amblyopia were significantly commoner in females, were larger lesions and presented at an earlier age. Intralesional steroids appear to cause a reduction of blood flow, with a transient reduction in volume and a suppression of the natural cyclic variation seen without treatment. The changes after a course of steroid therapy appear to last for between 5 and 20 months, this period of suppression of the lesion probably being particularly useful during infancy and early childhood when the child is at greatest risk of amblyopia.
Verity
David H
DH
Orbital Clinic, Moorfields Eye Hospital, London, England.
Rose
Geoffrey E
GE
Restori
M
M
D000550:Amblyopia / Q000209:etiology / Q000517:prevention & control; D001783:Blood Flow Velocity; D003907:Dexamethasone / Q000008:administration & dosage*; D005134:Eye Neoplasms / Q000098:blood supply / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D018324:Hemangioma, Capillary / Q000098:blood supply / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015552:Injections, Intralesional; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D018615:Ultrasonography, Doppler, Color
D005938:Glucocorticoids; D003907:Dexamethasone; D008775:Methylprednisolone