YAG-Laser in the therapy of capillary eyelid-hemangioma in childhood
F. Sulimma, A. von Scheven, W. E. Lieb
Introduction: Capillary hemangiomas often show spontaneous involution. A therapeutic intervention is only necessary if there is a risk of amblyopia. A good therapeutic option is the cw-Neodymium-YAG-Iaser -used for therapy of vascular malformations in dermatology - in combination with intralesional injection of corticosteroids.
Patients and methods: Because of a progredient hemangioma of the upper eyelid which covered the optical axis and/or induced an astigmatism we treated 12 children (median of age 4.0 months) with a cw-Nd:YAG-Iaser in general anaesthesia. The operation area was cooled with ice before, during and after the lasertreatment which varied relative to number of effects, power of the single effect (4 to 12 W) and exposure time (1.5 to 5sec) according to the extension of the hemangioma. Subsequently up to 40mg Triamcinolon and 4mg Dexamethasone were injected in the tumor. Two children had to be retreated .
Results: All treated hemangiomas showed good and quick resolution with release of the optical axis and paling of the tumor despite a post-operative lidedema. Because of an incomplete regression a second lasertreatment became necessary in two cases. Once there occured a mild skin necrosis in the treated area. Complications due to the corticosteroids did not appear. The development of visual acuity was normal in 8 children in the course, three children had a visual acuity in the lower normal range. Only one child still showed a visual reduction on the involved site in the age of three years. Manifest astigmatism remained in 11 of the 12 little patients varying from -0.5 to 5.0 diopters.
Conclusions: If there is an indication for therapeutic intervention in capillary hemangiomas of the eyelid the cw-Neodymium-YAG-Iaser- treatment represents in combination with intralesional injection of corti- costeroids an effective and safe therapeutical option.
University Eye Hospital, Josef-Schneider-Str. 11, D-97080 Würzburg, Germany