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Editor,—Tunç et alpublished a thorough analysis of the course and management of orbital lymphangiomas. They state that besides careful and sometimes repeated surgery there is little convincing evidence of other promising treatment options: “ . . .few patients have been treated with other modalities including . . .sclerosing agents but there are sparse data with those approaches”.1 The latter fact might be the result of failures, which have not been published. Therefore, we would like to communicate own disappointing results. Recently, the intralesional application of OK 432 (Picibanil, Chugai Pharmaceuticals Co, Tokyo, Japan) has been used successfully in the treatment of lymphangiomas in various body sites.2 Usually, OK 432 is injected in one of the cystic spaces of the tumour, leading to an inflammatory reaction and finally to complete shrinking of the tumour within 4–8 weeks. Encouraged by our own good experiences in the treatment of childhood lymphangiomas of the neck or trunk, we decided to choose this approach in the case of a 22 year old young woman suffering from a histologically proved lymphangioma of the left conjunctiva and anterior orbit. The tumour initially presented in early childhood but did not show significant growth until end of the second decade. One surgical debulking procedure had not led to a satisfactory result. Therefore, we performed two injections of OK 432 within 4 weeks. Though we observed the expected inflammatory reaction and swelling, this was not followed by an involution of the tumour. Three months after OK 432 treatment the prolapse of the conjunctival part of the tumour had even increased. A second and now more successful surgical reduction of the mass was necessary. While we have no explanation for the failure of OK 432 in our case, we believe that, though very successful in other localisations, this treatment might be inappropriate in cases of orbital lymphangioma.
Editor,—There is a paucity of data on the use of OK 432 in this condition. I have also seen one case with the orbit involved in which this treatment was unsuccessful. Perhaps the Japanese centres will present data from a controlled trial, but from my case and anecdotal reports (including the current one) I have not been impressed. The obvious concern is not to reinvent the wheel regarding minimally effective therapies. In both orbital haemangiomas and lymphangiomas several treatments were advocated for many years with minimal effect; hopefully this will not be another one.