Orbital lymphaticovenous malformations: Current and future treatments

Normalization of Congenital Venous Stasis Retinopathy Following Sclerotherapy of a Macrocystic Lymphatic Malformation

The authors describe, for the first time to their knowledge, a case of a congenital macrocystic lymphatic malformation of the orbit with associated venous stasis retinopathy that acutely normalized after drainage and sclerotherapy of the lesion. Prenatal ultrasound revealed prominence of the left orbital soft tissue, and at birth, the patient was noted to have unilateral proptosis, tortuous retinal vessels, and intraretinal hemorrhages in all 4 quadrants in the left eye. MRI demonstrated a primarily intraconal, multiloculated, T2-hyperintense mass consistent with a lymphatic malformation. Ultrasound-guided cyst aspiration and sclerotherapy was performed, with subsequent improvement of the proptosis and resolution of the vessel tortuosity and intraretinal hemorrhages. Although venous stasis retinopathy is usually related to central retinal vein occlusion or carotid artery occlusive disease, any entity that increases orbital venous resistance can generate retinal venous dilation and intraretinal hemorrhages, including an orbital lymphatic malformation.

A prospective study of the role of intralesional bleomycin in orbital lymphangioma

PURPOSE

To evaluate the efficacy of intralesional bleomycin injection in the management of lymphangiomas of the orbit.

METHODS

This prospective noncomparative interventional case study included 13 patients with orbital lymphangiomas. Reconstituted bleomycin 1-5 ml (0.5 IU/kg body weight; maximum, 15 IU/ml) was injected with 2% lignocaine in the lesion as seen on imaging or, in deeper lesions, under ultrasound guidance. Repeat injections were administered when required after every 4 weeks. The decision to retreat was based on clinical and radiological evidence of response.

RESULTS

Patients were treated with 1-6 injections of bleomycin 0.5 IU/kg body weight. Dramatic response was achieved in all cases. During the mean follow-up period of 19.69 months (range, 7-26 months) none of the patients experienced recurrence or significant complication.

CONCLUSIONS

In this patient cohort lymphangiomas of the orbit showed favorable and promising results with intralesional injections of bleomycin. This treatment should be considered as a first-line therapy for lymphangiomas of the orbit.

Update on orbital lymphatic malformations

PURPOSE OF REVIEW

The purpose of this article is to review the recent published literature in 2015 on lymphatic malformation and provide updated information on the disease. Specifically, this article will describe recent advances in identifying and managing lymphatic malformations.

RECENT FINDINGS

All articles discussed in this article emphasize the difficulty in treating lymphatic malformations. Most patients have long complicated histories with multiple recurrences. Studies are trying to identify which lesions will be successful treated by certain therapeutic modality. Treatment includes nonsurgical and surgical therapies.

SUMMARY

Lymphatic malformations are difficult lesions to treat because they do not respect tissue planes. The use of sclerosing agents shows great promise for treating macrocysts. More knowledge is needed in the development of the disease process. Hopefully, antilymphangiogenic agent can provide targeted treatment.