Visual development in infants: visual complications of periocular haemangiomas

R C Frank, B J Cowan, A R Harrop, W F Astle, D F McPhalen
Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS 2010, 63 (1): 1-8

UNLABELLED: Periocular haemangioma of childhood can severely impact visual development.

OBJECTIVE(S): To review our experience with 20 periocular haemangioma patients; to review infant ocular development in the context of periocular capillary haemangioma; to identify early clinical warning signs that may precede devastating visual outcomes in the absence of timely management and to review our experience with surgical debulking for the treatment of selected periocular haemangioma.

DESIGN: Retrospective case series.

INTERVENTIONS: Twenty children with congenital periocular haemangiomas received care by a multidisciplinary team consisting of doctors from the specialties ophthalmology, plastic surgery, paediatrics and dermatology. The patients were separated by age at presentation to our centre (<or=1 year and >1 year). Based on consensus amongst the team, certain patients were considered to be at high risk for development of amblyopia, permanent cortical visual change or blindness. These patients were scheduled for urgent surgical excision or debulking. The effect of treatment on visual development over time was evaluated.

RESULTS: Patients presenting to our centre after 1 year of age were more likely to have amblyopia (75% vs. 0% if presenting at <or=1 year of age) and were more likely to have had a series of failed interventions. Lesions ranged in size from 5 to 105 mm, with four patients having lesions that were described as 'massive'. Surgical debulking was performed in 12 patients. Mean time to surgery from the decision to operate was 7.8 days (in the 'high risk' <or=1-yr group), and mean patient age at surgery was 2.5 months. No complications were incurred during surgical debulking.

CONCLUSION: Early identification and multidisciplinary treatment of 'high risk' periocular haemangiomas, at imminent risk of causing amblyopia, is essential. Some 'high-risk' lesions are clinically deceiving and display an apparent open visual axis. Early surgical debulking of these lesions can provide immediate decompression of the globe and allow for preservation of normal vision. Conversely, a 1-2-week period of visual deprivation, in children under 2 years of age, can result in permanent cortical visual deficits.

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