title: Management of periorbital microcystic lymphatic malformation with blepharoptosis: Surgical treatment combined with intralesional bleomycin injection.
abstract: OBJECTIVE
  Periorbital microcystic lymphatic malformations (LM) can cause severe symptoms, such as blepharoptosis, amblyopia, chemosis, strabismus, diminished vision, and blindness. The purpose of this study was to evaluate the clinical outcome in periorbital microcystic LM patients with blepharoptosis who underwent surgical treatment combined with intralesional bleomycin injection.
  
  
  METHODS
  A retrospective study including nine patients diagnosed as periorbital microcystic LM with blepharoptosis was conducted. All of the patients underwent surgical treatment and bleomycin injection from January 2010 to January 2014. The lesion was resected through the lower eyebrow and/or a coronal incision at the first stage, and levator resection was performed at the second stage. Any persistent lesion or its recurrence was managed by intralesional bleomycin injection.
  
  
  RESULTS
  Blepharoptosis and visual obstruction were corrected in all patients. Mean follow-up was 24.6 months. Six patients had recurrence during the follow-up, and two patients who had partial eyelid closure after the second stage surgery recovered in three months. Amblyopia, astigmatism, and strabismus were not improved after treatment. All of the patients had excellent aesthetic improvement and corrected blepharoptosis.
  
  
  CONCLUSIONS
  Resection through a lower eyebrow and coronal incision and levator resection performed in two stages can quickly correct the visual impairment caused by periorbital microcystic lymphatic malformation with blepharoptosis. Intralesional bleomycin injection is a promising adjunctive therapy for residual or recurrent lesions after surgery.
authors.affiliation: Department of Plastic Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University, School of Medicine.
authors.forename: Xi
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Plastic Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University, School of Medicine.
authors.forename: YunBo
authors.initials: Y
authors.lastname: Jin
authors.affiliation: Department of Plastic Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University, School of Medicine. Electronic address: linxiaoxi@126.com.
authors.forename: XiaoXi
authors.initials: X
authors.lastname: Lin
authors.affiliation: Department of Plastic Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University, School of Medicine.
authors.forename: Hui
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Plastic Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University, School of Medicine.
authors.forename: Gang
authors.initials: G
authors.lastname: Ma
authors.affiliation: Department of Plastic Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University, School of Medicine.
authors.forename: XiaoJie
authors.initials: X
authors.lastname: Hu
authors.affiliation: Department of Plastic Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University, School of Medicine.
authors.forename: YaJing
authors.initials: Y
authors.lastname: Qiu
authors.affiliation: Department of Plastic Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University, School of Medicine.
authors.forename: WenXin
authors.initials: W
authors.lastname: Yu
authors.affiliation: Department of Plastic Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University, School of Medicine.
authors.forename: Lei
authors.initials: L
authors.lastname: Chang
authors.affiliation: Department of Plastic Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University, School of Medicine.
authors.forename: TianYou
authors.initials: T
authors.lastname: Wang
mesh_terms: D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D001761:Bleomycin / Q000627:therapeutic use*; D019882:Blepharoplasty; D001763:Blepharoptosis / Q000209:etiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015552:Injections, Intralesional; D044148:Lymphatic Abnormalities / Q000150:complications / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000903:Antibiotics, Antineoplastic; D001761:Bleomycin
keywords: Bleomycin; Blepharoptosis; Microcystic lymphatic malformation; Periorbital; Surgery; Visual obstruction