Elsevier

Ophthalmology

Volume 115, Issue 2, February 2008, Pages 390-397.e1
Ophthalmology

Original article
Reappraisal of Astigmatism Induced by Periocular Capillary Hemangioma and Treatment with Intralesional Corticosteroid Injection

https://doi.org/10.1016/j.ophtha.2007.03.077Get rights and content

Objective

To document refractive status and visual acuity before and after intralesional corticosteroid injection in children with astigmatism induced by periocular capillary hemangioma (PCH).

Design

Retrospective, interocular comparison, interventional case series.

Participants

Thirteen infants with anisometropic astigmatism of at least 1.50 diopters (D) induced by PCH.

Intervention

All infants had one or more intralesional corticosteroid injections of a PCH between 2 and 10 months of age. Injections of 0.3 to 1.0 ml of a 50:50 mixture of triamcinolone (40 mg/ml) and dexamethasone phosphate (4 mg/ml) were given at a single site under deep sedation.

Main Outcome Measures

Refraction and acuity using Teller acuity cards before and after injection.

Results

In affected eyes, mean astigmatisms were 3.75 D (pretreatment) and 1.25 D (posttreatment), and mean spherical errors were 0.75 D (pretreatment) and 1.50 D (posttreatment). Reduction in astigmatism was observed within 1 to 14 months after the injection. Despite reciprocal changes in astigmatism and spherical error, the amount of anisometropia (spherical equivalent) remained constant. Amblyopia was not observed before treatment and was observed in only 2 of 13 children after treatment. Complications were limited to adrenal suppression with transient reductions of linear growth and localized eyelid necrosis.

Conclusions

Intralesional corticosteroid injections given in infancy (between 2 and 10 months) resulted in a 63% reduction in the mean amount of astigmatism induced by PCH. The reciprocal changes of astigmatism and spherical error without changes in anisometropia suggest that the treatment effect was due to restoration of the spherical shape of the cornea. Before 3 years of age, visual immaturity exceeded the optical blur related to astigmatism induced by PCH. Therefore, astigmatism, not anisometropia or amblyopia, is the immediate indication for treatment of PCH with intralesional corticosteroids. Injection of corticosteroid at a single site minimizes the potential for severe ocular complications owing to tissue pressure and tumor volume considerations.

Section snippets

Materials and Methods

Records of 14 infants with PCH treated consecutively with intralesional corticosteroid injections for astigmatism at Children’s Hospital and Regional Medical Center between January 1994 and June 2005 were reviewed. Infants with papillary occlusion due to eyelid ptosis were excluded. Threshold for treatment was anisometropic astigmatism of at least 1.50 diopters (D). All infants were treated before 1 year of age by one of the authors (AHW). We limited our analysis to 13 of the 14 infants who had

Results

Our study included 13 infants (10 female) with a mean age of 4.7±2.7 months (range, 2–10) at initial ophthalmologic examination (Table 1 [available at http://aaojournal.org]). All infants had capillary hemangiomas confined to the periocular region. Nine infants had upper lid involvement; 3 of these had orbital extension. Four infants had lower lid involvement. The basal dimensions of all tumors were at least 1.0×1.0 cm. Follow-up acuity and refractive data were collected for a mean duration of

Discussion

We found that a single intralesional corticosteroid injection in infancy resulted in a 63% reduction in the mean amount of astigmatism induced by PCH. Our observations confirm those of previous investigators. Kushner reported a 64% reduction in anisometropic astigmatism of ≥2.50 D in 3 infants between 2 and 10 months of age.6 Morrell and Willshaw showed a 56% reduction of astigmatism of ≥1.50 D in 6 of 6 infants younger than 1 year and minimal or no reduction in 3 of 4 older children.9 Similar

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    Manuscript no. 2006-1134.

    Work done in the Roger H. Johnson Clinical Vision Laboratory, Children’s Hospital and University of Washington Medical Centers. Preliminary draft presented at: Association for Pediatric Ophthalmology and Strabismus annual meeting, 2006, Keystone, Colorado.

    Supported by an unrestricted grant from the Peter LeHaye, Barbara Anderson, and William O. Rogers Funds.

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