Treatment of orbital vascular malformations with intralesional injection of pingyangmycin

Background To evaluate the safety and efficacy of intralesional pingyangmycin for treatment of orbital vascular malformations. Methods Thirteen patients received intralesional injections of pingyangmycin at the Eye and ENT Hospital of Fudan University. CT scans of each patient were evaluated with graphic processing software to measure lesion volumes before and after treatment. Results Of five men and eight women patients averaging 36 years old, six were diagnosed with venous malformations, six with cavernous haemangiomas, and one with lymphangioma. Proptosis and eyelid swelling were the most common presenting signs. The mean preoperative lesion volume was 4.4 +/- 2.3 cm(3) (range, 1.6-8.8 cm(3)), and the average postoperative volume was 1.5 +/- 1.7 cm(3) (range, 0.2-6.6 cm(3)) after a single pingyangmycin injection, the dose of which averaged 4.2 mg (range, 2-6 mg). The mean percentage of volume reduction was 70.0% (range, 24.5-88.3%), whereas proptosis reduction averaged 3.2 mm (range, 0-5.5 mm). The lesion volume and proptosis reductions were both statistically significant (p<0.001, and p=0.001). No adverse local or systemic side effects occurred in any of the patients during follow-up averaging 13.3 months. Histopathology of a cavernous haemangioma that underwent a second injection through a surgical incision, showed a mild chronic inflammatory response, increased numbers of myofibroblasts, loss of vascularity and fibrosis, all consistent with known effects of bleomycin treatment. Conclusions Intralesional injection of pingyangmycin for the treatment of orbital vascular malformations is an effective method that involves mild inflammation, fibrosis, and reduced vascularity of the malformation.