Bleomycin for orbital and peri-orbital veno-lymphatic malformations – A systematic review

Abstract

Background Orbital and peri-orbital venolymphatic malformations (VLM) are low flow vascular malformations. Intralesional bleomycin is now commonly being used to treat such malformations. Objective The purpose of this systematic review is to synthesize evidence on the safety and efficacy of bleomycin/pingyangmycin sclerotherapy for the treatment of orbital and peri-orbital VLM. Methods We searched Medline, Embase, Scopus and Cochrane database for studies reporting outcomes of bleomycin/pingyangmycin sclerotherapy for orbital and peri-orbital VLM between 1974 to April 5th, 2019. Nine retrospective cohort studies enrolling 132 patients were included. Two reviewers independently screened and extracted data and assessed the risk of bias. Predefined outcome measures were subjective and objective reduction of the lesion and associated complications. Results Subjective reduction of the lesions was seen in 96.2% of the studies. Objective reduction of the lesion and symptomatic improvement were reported in 91.6 and 95% of the studies respectively. Non responders were 9.0%. Minor adverse events were reported in 18.1% of the studies. Major complications like pulmonary toxicity or pulmonary fibrosis was not encountered in any of the included studies. Quality of evidence was generally low. Conclusion Bleomycin/pingyangmycin sclerotherapy is very effective and relatively safe for the treatment of orbital and periorbital VLM and is not associated with any major side effects including pulmonary fibrosis. Limitations: The systematic review is limited mainly due to low quality of the included studies with retrospective design.

Bleomycin for Percutaneous Sclerotherapy of Venous and Lymphatic Malformations: A Retrospective Study of Safety, Efficacy and Mid-Term Outcomes in 26 Patients

“…Pingyangmycin sclerotherapy achieved subjective or objective lesion size reduction in 96.3% [ 23 ]. Another meta-analysis of nine retrospective cohort studies involving 132 patients suffering from orbital and peri-orbital veno-lymphatic malformations assessed results of sclerotherapy [ 24 ]. When LMs and VMs were treated with bleomycin, objective reduction was achieved for 78.5% and 100% of the patients, respectively.…”

“…Minor complications rate was less than 10% for pingyangmycin and around 26% with bleomycin. No major complications were reported with the use of pingyangmycin [ 24 ].…”

Vascular lesions of the pediatric orbit: A radiological walkthrough

“…To date, only a few of them benefits from specific and curative therapies. The available treatments are medical, surgical, interventional, laser or combined: particularly, the fortuitous discovery that it was effective in regressing hemangiomas made the non-selective β-adrenergic receptor blocker propranolol a first-line therapy for these patients (84)(85)(86)(87).…”

Orbital Venolymphatic Malformation Treated With Sodium Tetradecyl Sulfate: A Case Report

“…Orbital and periorbital venolymphatic malformations (VLMs) are benign congenital vascular lesions and constitute 1%-3% of all orbital masses [ 1 ]. Complications include intralesional hemorrhage, cellulitis, amblyopia, blepharoptosis, periocular edema, proptosis and impaired visual acuity (VA) [ 2 ].…”