Steroid therapy for problematic proliferating haemangioma.

AIM: To evaluate the effectiveness and the safety of systemic and intralesional steroid therapy for problematic proliferating haemangioma. METHOD: 233 patients with haemangioma were identified from our vascular anomalies database 1996-2007. 46 (36%) out of 129 patients with proliferating haemangioma required intervention. 24 of these patients received steroid therapy. Indications for steroid therapy, the response and side effects of treatment and the need for other treatment were recorded. Intralesional triamcinolone up to 4 mg/kg/injection was preferred for small, localised non-periorbital lesions in 5 patients and oral prednisolone 2.0-2.5 mg/kg/day was used for larger lesions, especially around the periorbital region in 19 patients. RESULTS: Accelerated regression of the haemangioma was observed in four of the five patients who received intralesional triamcinolone and there was no complication. Overall, the haemangioma in 17 (89%) of the 19 patients responded to high dose oral prednisolone with accelerated regression noted in 10 (53%) patients. Rebound growth was observed in 5 patients during dose tapering, requiring dose increment in three patients and debulking surgery in one patient. Three patients developed growth retardation during treatment but this normalised 3-10 months following cessation of steroid therapy. Other side effects included mild Cushingoid features (n=2), irritability (n=2), increased appetite (n=3). CONCLUSION: Intralesional and systemic steroid are relatively safe and effective in treating problematic proliferating haemangioma. Systemic steroid therapy is associated with few short-term side effects. A multidisciplinary management is essential. Propranolol is likely to replace steroid as the first-line treatment for problematic proliferating haemangioma.

W(h)ither orbital pseudotumor?

Orbital pseudotumor is a nonspecific, idiopathic benign inflammatory process characterized by a polymorphous lymphoid infiltrate with varying degrees of fibrosis. We retrospectively reviewed the clinical presentation, management, and progress of six consecutive patients referred to our service with an initial diagnosis of orbital pseudotumor to underscore the challenge and pitfalls in managing this group of patients. Three male and three female patients, aged 27 to 74 years, presented with a variety of ophthalmologic problems, including orbital swelling, chemosis, proptosis, blepharoptosis, restricted eye motion, diplopia, and visual loss. The initial diagnosis of orbital pseudotumor was based on clinical findings, results of routine laboratory screening tests, computed tomographic and/or magnetic resonance imaging scans, and the response to corticosteroid treatment in three patients. In these three patients, the final diagnosis of orbital pseudotumor was confidently made only in one patient who remained in remission after corticosteroid therapy. The remaining two patients had Miller-Fisher syndrome and thyroid ophthalmopathy. Three other patients initially diagnosed with orbital pseudotumor underwent biopsy through an orbitotomy with comprehensive histopathologic evaluation. Two of these patients were subsequently diagnosed with non-Hodgkin lymphoma. Orbital pseudotumor belongs to a spectrum of lymphocytic infiltrative orbital conditions. It is a diagnosis of exclusion. The initial diagnosis must be regarded as provisional, and failure of complete resolution with corticosteroid therapy should heighten the index of suspicion and a biopsy should be considered. However, diagnosis may be difficult even with comprehensive histopathologic studies.

Recurrent anterior chamber hemorrhage from an intraocular lens simulating amaurosis fugax.

Uveitis-glaucoma-hyphema syndrome is a rare late complication of anterior segment surgery. We present 2 unusual cases of this syndrome that were mistakenly diagnosed as amaurosis fugax, leading to contraindicated treatment. These cases illustrate the need for ophthalmologic examination during an episode of symptoms.

Recovery of vision after bilateral arteritic central retinal artery occlusion.

A case is reported of a patient with bilateral central retinal artery occlusion secondary to giant cell arteritis. After treatment the vision recovered in one eye but remained poor in the other eye. Treatments employed are discussed with particular attention drawn to differences in the treatment of each eye and suggestions are made for treatment of similar cases.