Intralesional Photocoagulation of Periorbital Hemangiomas

Abstract

The purpose of this study was to examine the effects of intralesional bare fiber photocoagulation with the KTP and Nd:YAG lasers on periorbital hemangiomas of infancy. Initial reports by Apfelberg and Gregory suggest that intralesional laser therapy may have a role in the treatment of hemangiomas. Intralesional photocoagulation may be preferred to superficial laser treatment for several reasons. It may decrease cutaneous skin damage and more effectively reduce bulky, deep lesions. Twenty-three patients with periorbital hemangiomas were treated (KTP, n = 7; Nd:YAG, n = 16). An 18-g Angiocath was placed into the lesion to pass the fiber through. Laser energy was delivered by means of a 0.6-mm bare fiber at 10 to 15 J (KTP) or 7 J (Nd:YAG). Treatments were done under general anesthesia. Patients were followed closely for 1 month and then monthly to assess results and complications. Results are as follows: 61 percent demonstrated 50-percent or more reduction at 3 months; 22 percent demonstrated 50-percent or more reduction in 3 to 8 months, i.e., 83 percent of patients had 50-percent or more reduction within 8 months. To achieve these results, two patients required two treatments. The remaining 17 percent had 10- to 14-percent reduction at 1 to 3 months. Two of these patients had two treatments. A subgroup of patients had a very dramatic response. Thirty-five percent (8 of 23) had 50- to 90-percent reduction in 1 month. It is unclear why these patients responded so dramatically. We expected some ulceration during the healing phase. Seventeen percent developed ulceration. Complications were limited (4 percent) to one wound infection. Intralesional photocoagulation treatment with the KTP and Nd:YAG lasers is effective and safe for the treatment of periorbital hemangiomas in the majority of patients with minimal complications. Further study is necessary to identify factors that result in dramatic or limited responses.

Benign Cutaneous Vascular Tumors of Infancy

“…78,79 Intralesional photocoagulation treatment with the potassium-dianyl-phosphate and Nd:YAG lasers has also been used for periorbital hemangiomas. 80 Systemic corticosteroids alter hypothalamic-pituitaryadrenal function within a few days following therapy initiation, especially if administered twice daily. 81 Thus, singlemorning dosing is preferred.…”

Malformaciones venosas orofaciales de bajo flujo: esclerosis endoluminal con láser de diodo

“…Inicialmente el láser Nd:YAG se utilizó para realizar tratamientos de hemangiomas y MVBF orales en modo continuo con irradiación de la superficie de la lesión y conseguir así esclerosis de la misma sin punción 13 . Sin embargo, esta forma de tratamiento en superficie precisa la aplicación de frío local para evitar la necrosis de la mucosa que recubre la lesión 7 .…”

“…Podemos, en casos más complejos, apoyarnos en la ecografía guiada para estar seguros de que la aplicación de toda la energía de fotocoagulación que nos proporciona el láser sea intralesional 10,11,13 . El grado de energía que se absorbe por el tejido una vez aplicado el láser no es apreciable en los efectos sobre dicho tejido de inmediato, sino posteriormente, con el consecuente riesgo de necrosis postoperatoria.…”

Treatment of hemangiomas and port‐wine stains with emphasis on lasers

“…Intralesional laser photocoagulation using a bare quartz fiber coupled with a diode or Nd:YAG laser is another method of photocoagulating deep hemangiomas (25,26). Intralesional laser photocoagulation using a bare quartz fiber coupled with a diode or Nd:YAG laser is another method of photocoagulating deep hemangiomas (25,26).…”