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SATURDAYOctober 16RAPID FIRE
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Bryce Cowan Periocular hemangiomas of childhood may change the visual axis leading to astigmatism, amblyopia or blindness. Objective(s): Retrospective review of our experience with 15 periocular hemangioma patients; to review infant ocular development in the context of periocular capillary hemangioma; identification of warning signs that may precede devastating visual outcomes. Interventions: 15 children with congenital periocular hemangiomas received multi-disciplinary care by ophthalmology, plastic surgery, paediatrics and dermatology. Patients were separated by time of presentation to our centre (=1 year and > 1 year). Team consensus identified “high risk” patients for the development of amblyopia, permanent cortical visual change, or blindness. These patients underwent urgent surgical debulking. Treatment effect on visual development was evaluated. Results: Periocular hemangiomas were more common in girls (87% of our series) and the upper lid was the most common isolated location. Patients presenting after one year of age were more likely to have amblyopia (75% vs. 0% if presenting =1 year of age) and more likely to have had multiple failed interventions. Lesion size ranged from 16.6 to 35.5 mm. Three patients had lesions described as ‘massive'. Surgical debulking was performed in 10 patients (6 for “high risk” lesions, 4 for cosmesis). Mean time to surgery was 8.3 days (“high risk” = 1 yr group) and mean age at surgery was 4.4 months. Vision was protected in a sustained fashion where risk to vision was a pre-operative concern (follow-up 12-32 months). Conclusions: (1) Early identification and multi-disciplinary treatment of “high risk” periocular hemangiomas, at imminent risk of causing amblyopia, is essential. (2)“High risk” lesions may be clinically deceiving and display an apparent open visual axis. (3) 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 < 2 years of age, can result in permanent cortical visual deficits.
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