Combined surgical method of orbital and periorbital hemangioma treatment in infants.

PURPOSE: To analyze the results of application of combined surgical treatment in different forms of hemangioma in infants. MATERIALS AND METHODS: One hundred seventy-four children with different forms of orbital and periorbital hemangiomas aged 1-16 months (mean age 5.2 + 1.97 months) were operated on at the pediatric ophthalmology department. Fast growth of hemangioma, both superficial (intradermal) and deep (subdermal and orbital) localization, significant deformity of eyelids, with narrowing of eye fissure were the indications for surgical treatment. The combined-staged method, including cryosurgery of superficial intradermal lesions and surgical excision of subdermal and/or orbital parts of the tumor in different combinations depending on the form and depth of hemangioma spreading, was applied. RESULTS: Usage of cryodestruction usually on the first stage of treatment allowed gentle scarring of the angiomatously changed skin areas. Surgical excision of the deep part of the tumor eliminated disfigurement and visual axis occlusion, avoiding amblyopia development. Good cosmetic and anatomic result was achieved in 90.4% of cases. CONCLUSION: Combined surgical method of treatment of progressive capillary hemangiomas by using cryosurgery and surgical excision in infants allows the choice of optimum tactics depending on features of the course and clinical picture in each individual case and provides achievement of high cosmetic and functional result of treatment. The early beginning of treatment in cases of fast progressing of the tumor allows prevention of extensive skin affection and amblyopia development.

Clinical and anatomical substantiation of levator resection in the complex surgical treatment of BPES.

OBJECTIVE: To describe the clinical and anatomical results of the complex one-stage surgical treatment of BPES by means of levator resection. MATERIALS AND METHODS: 51 children (73 eyes) aged 3-16 years with BPES were operated on by the newly developed one-stage technique at the Pediatric Ophthalmology Department of the Filatov Institute of Eye Diseases and Tissue Therapy. The surgical technique included shortening of the internal canthal ligament, resection of the tarsus and levator muscle, and skin plasty. The new surgical technique is based on new data on the topography of the upper eyelid and anterior part of the orbit obtained by MRI-onward protrusion of the orbital septum with increased volume of the pre-aponeurotic fat pad; thickening of the suborbicularis fat layer; shortening and thickening of the mobile part of the upper eyelid; and slight expression and low position of the palpebral fold. RESULTS: Elimination of ptosis and epicanthus was achieved in all cases (eye fissure widening of up to 7-11 mm, average 8.8 +/- 1.04 mm, and lengthening of up to 21-30 mm, average 24.7 +/- 2.87 mm). Increased levator function to 3-10 mm (average 5.6 +/- 0.19 mm) was also achieved after surgery. Control MRI investigation confirmed the normalization of the topography of the eyelid and orbital structures. CONCLUSION: The newly developed surgical technique for BPES correction by means of levator resection permits one to obtain high cosmetic and functional results based on improvement of the topography of the upper eyelid and orbital structures.