Clinical and radiological outcomes of intralesional bleomycin for orbital venolymphatic malformations: A retrospective case series

Abstract

Background: Intralesional sclerotherapy with bleomycin could be an alternative to surgical excision in the management of orbital venolymphatic malformation (VLM); it could be the sole and primary modality of treatment. Bleomycin represents one of the anti-neoplastic agents that induce significant scarring and fibrosis in the case of local injection into the lesion. It is a sclerosing agent, so it helps in the regression of the lesion.
Aim: The study aims to assess how safe and efficient bleomycin sclerotherapy is when used for treating Orbital and periorbital VLM.
Setting: A retrospective case series with Orbital VLM.
Methods: A retrospective case series of orbital VLM. The cases were assessed ophthalmologically, received intralesional bleomycin and were followed for 3 years. The clinical and radiological responses were evaluated. The number of injections, recurrence and complications were recorded.
Results: This study included 17 cases with a median age of 8 years (interquartile range [IQR] 2.5 years–16.5 years), with a minimum of 9 months and a maximum of 20 years. Of these, eight were females, while nine were males. The lesions were classified as intraconal in three cases, extraconal in seven and in the anterior orbit in seven. Furthermore, two patients received only one injection with complete resolution. Nine patients received two injections with complete resolution. In addition, four patients received three injections with complete resolution, achieving an overall complete resolution rate of 88.2% (95% confidence interval [CI]: 65.7% – 96.7%). No serious side effects were observed.
Conclusion: Bleomycin sclerotherapy showed promising efficacy with acceptable short-term and intermediate-term safety in the management of orbital and periorbital VLM.
Contribution: It contributes to the understanding of bleomycin in the management of orbital and periorbital VLM.