Reappraisal of Astigmatism Induced by Periocular Capillary Hemangioma and Treatment with Intralesional Corticosteroid Injection
Received 9 October 2006; received in revised form 2 March 2007; accepted 10 March 2007. published online 22 June 2007.
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.
Available online: June 22, 2007.
1Division of Ophthalmology, Children’s Hospital and Regional Medical Center, Seattle, Washington.
2Department of Ophthalmology, University of Washington, Seattle, Washington.
Correspondence to Avery H. Weiss, MD, Division of Ophthalmology, Children’s Hospital and Regional Medical Center, 4800 Sand Point Way NE, Seattle, WA, 98105.
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.
ABSTRACT